Download - Congestive Heart Failure - Students
-
8/13/2019 Congestive Heart Failure - Students
1/136
Congestive Heart Failure
Cindy Chan, MD
-
8/13/2019 Congestive Heart Failure - Students
2/136
Inability of the heart to pump blood
forward sufficiently to meet the
metabolic needs of the body
or the ability to do so only with anabnormally high filling pressure
Heart Failure
-
8/13/2019 Congestive Heart Failure - Students
3/136
Coronary heart
disease
Hypertension
Valvular disease
Congenitalheart disease
Cardio-
myopathy
CHF
-
8/13/2019 Congestive Heart Failure - Students
4/136
Epidemiology
5 million in US
500,000 new cases years
75% new cases in pts >65yo
-
8/13/2019 Congestive Heart Failure - Students
5/136
What do I need to
remember aboutCARDIAC PHYSIOLOGY?
-
8/13/2019 Congestive Heart Failure - Students
6/136
Cardiac output
Heart rate Stroke volume
Preload Contractility
Afterload+
+
-
8/13/2019 Congestive Heart Failure - Students
7/136
WHAT IS PRELOAD?
Amount of muscle stretchbefore contraction
-
8/13/2019 Congestive Heart Failure - Students
8/136
LV End-diastolic VOLUME
STROKEVOLUME
-
8/13/2019 Congestive Heart Failure - Students
9/136
LV End-diastolic VOLUME
STROKEVOLUME
FRANK - STARLING
-
8/13/2019 Congestive Heart Failure - Students
10/136
LV End-diastolic VOLUME ~
LV End-diastolic PRESSURE
STROKEVOLUME
FRANK - STARLING
-
8/13/2019 Congestive Heart Failure - Students
11/136
LV End-diastolic VOLUME ~
LV End-diastolic PRESSURE
STROKEVOLUME
FRANK - STARLING
but the relationship
between volume
and pressureis not linear!
-
8/13/2019 Congestive Heart Failure - Students
12/136
The LV end-diastolicPRESSURE / VOLUME
relationship
is influenced by theLV chamber compliance
-
8/13/2019 Congestive Heart Failure - Students
13/136
LV
Pressure
LV Volume
Stiff Normal
Compliance
-
8/13/2019 Congestive Heart Failure - Students
14/136
-
8/13/2019 Congestive Heart Failure - Students
15/136
EDV
ESV
SV = EDV - ESV
-
8/13/2019 Congestive Heart Failure - Students
16/136
Baseline
Increase
in EDV(preload)
EDV- ESV = SV
-
8/13/2019 Congestive Heart Failure - Students
17/136
Baseline
Increase
inContractility
EDV- ESV = SV
-
8/13/2019 Congestive Heart Failure - Students
18/136
Baseline
Increase
inAfterload
EDV - ESV = SV
-
8/13/2019 Congestive Heart Failure - Students
19/136
Cardiac output
Heart rate Stroke volume
Preload Contractility Afterload+ +
-
8/13/2019 Congestive Heart Failure - Students
20/136
-
8/13/2019 Congestive Heart Failure - Students
21/136
Concepts to know
Preload
Afterload
Contractility
Compliance
Ejection fraction
-
8/13/2019 Congestive Heart Failure - Students
22/136
What are the
clinical manifestationsof CHF?
-
8/13/2019 Congestive Heart Failure - Students
23/136
Symptoms of CHFDyspnea on exertion (DOE)
Shortness of breath (SOB)
OrthopneaParoxysmal nocturnal dyspnea(PND)
Cardiac Asthma (with chronic cough)Fatigue
-
8/13/2019 Congestive Heart Failure - Students
24/136
Signs of Left-Sided CHF
Tachycardia
Tachypnea
Pulmonary Rales
Cardiomegaly
S S3 4
-
8/13/2019 Congestive Heart Failure - Students
25/136
Signs of Right-Sided CHF
Jugular vein distension
Edema
Hepatomegaly
-
8/13/2019 Congestive Heart Failure - Students
26/136
-
8/13/2019 Congestive Heart Failure - Students
27/136
-
8/13/2019 Congestive Heart Failure - Students
28/136
CHF
A Big Black Box
-
8/13/2019 Congestive Heart Failure - Students
29/136
CHF
A Big Black Box
Numerous etiologies,
pathophysiologies
and therapies
-
8/13/2019 Congestive Heart Failure - Students
30/136
-
8/13/2019 Congestive Heart Failure - Students
31/136
Pathophysiology
Low-output HF Left heart failure, right heart failure (LV dysfunction is primary
cause of RV failure)
High-output HF
Normal/supra-normal pump function, but increased metabolic
demands (thyrotoxicosis, severe anemia, arteriovenousshunting, Pagets disease of bone, thiamine deficiency)
Systolic dysfunction
Decreased contractility (ischemia, MI, DCMP, chronic AI/MR)
Increased afterload (HCMP, AS, HTN crisis, coarctation of aorta)
Diastolic dysfunction
Abnormal filling of LV or RV, because of impaired myocardialrelaxation or non-compliant/stiff chamber
-
8/13/2019 Congestive Heart Failure - Students
32/136
Etiologies of CHF
Coronary Artery Disease
Acute MI
Chronic ischemia
Hypertension
Cardiomyopathy
Dilated
HypertrophicInfiltrative
Valvular Disease
Mitral Regurgitation
Mitral Stenosis
Aortic RegurgitationAortic Stenosis
Pericardial Disease
Tamponade
Constriction
Congenital Disease
High output
Thyrotoxicosis
Beriberi
A-V Fistula
Pagets Disease
Anemia
Right-sidedPulmonary Hypertension
COPD
Pulmonary Embolism
Valvular Disease
Tricuspid RegurgitationTricuspid Stenosis
Pulmonic Regurgitation
Pulmonic Stenosis
-
8/13/2019 Congestive Heart Failure - Students
33/136
Etiologies of CHF Coronary heart disease
Hypertension
Cardiomyopathy
Dilated
HypertrophicInfiltrative
Valvular heart disease
Pericardial disease (Restrictive)
-
8/13/2019 Congestive Heart Failure - Students
34/136
Left ventricular
diastolic pressure
COMMON DENOMINATOR of LV FAILURE
Pulmonary capillary pressure
Left atrial pressureBAD
ELEVATED
-
8/13/2019 Congestive Heart Failure - Students
35/136
20 mmHg
NORMALELEVATEDLV DIASTOLICPRESSURE
-
8/13/2019 Congestive Heart Failure - Students
36/136
LV End-DiastolicPressure
LV End-Diastolic
Volume
LV End-Diastolic
Stiffness
Mechanism of Heart Failure
-
8/13/2019 Congestive Heart Failure - Students
37/136
Evaluation
of Systolic Function
-
8/13/2019 Congestive Heart Failure - Students
38/136
Ejection fraction:
EDV-ESV SV
EDV EDV=
-
8/13/2019 Congestive Heart Failure - Students
39/136
Evaluation of
Systolic Function
Systolic Function EF
NORMAL > 0.50FAIR 0.30 - 0.50
POOR
-
8/13/2019 Congestive Heart Failure - Students
40/136
Clinical Evaluation
Heart Failure
Abnormal
Diastolic
Function
Abnormal
Diastolic
Function
Heart failure is predominatelya disease of diastolic function
but systolic function mayvary!
-
8/13/2019 Congestive Heart Failure - Students
41/136
Clinical Evaluation
Heart Failure
Abnormal
Systolic
Function
Normal
Systolic
Function
70% 30%
-
8/13/2019 Congestive Heart Failure - Students
42/136
Clinical Evaluation
Heart Failure
AbnormalSystolic
Function
Normal systolic
function withprimary abnormal
Diastolic
Function
-
8/13/2019 Congestive Heart Failure - Students
43/136
Why does abnormal systolic function
lead to LV diastolic pressure?
Poor contraction leads to:
Use of Frank-Starling mechanism
End-diastolicpressure
Dilated LV
-
8/13/2019 Congestive Heart Failure - Students
44/136
Why does abnormal diastolic functio
lead to LV diastolic pressure
Poor compliance leads to:
Increase in LV pressure / volume
End-diastolicpressure
Stiff LV
-
8/13/2019 Congestive Heart Failure - Students
45/136
Dilated Cardiomyopathy
-
8/13/2019 Congestive Heart Failure - Students
46/136
Hypertrophic myopathy
-
8/13/2019 Congestive Heart Failure - Students
47/136
Which one has abnormalsystolic function?
-
8/13/2019 Congestive Heart Failure - Students
48/136
Systolic Dysfunction
Dilated Cardiomyopathy
Myocardial Infarction End-stage hypertension
Valvular heart disease
-
8/13/2019 Congestive Heart Failure - Students
49/136
Diastolic Dysfunction
Left Ventricular Hypertrophy
Hypertension
Aortic valve disease
Hypertrophic Cardiomyopathy
Restrictive Cardiomyopathy Constrictive Pericarditis
-
8/13/2019 Congestive Heart Failure - Students
50/136
Investigations !!
-
8/13/2019 Congestive Heart Failure - Students
51/136
Labs
Check for anemia, renal failure, thyroid
dysfunction, electrolyte abnormalities
(hyper/hypokalemia, hyponatremia)
BNP (brain natriuretic peptide; expressed
primarily in ventricles and elevated with
high ventricular filling pressures)
-
8/13/2019 Congestive Heart Failure - Students
52/136
EKG/CXR/Echo
EKGevaluate for underlying arrhythmia,
ischemia; often see low voltage, IV
conduction defects, LV hypertrophy
CXRcardiomegaly, pulmonary venous
congestion, pleural effusions (R-sided or
bilateral)
Echomost useful study
-
8/13/2019 Congestive Heart Failure - Students
53/136
Normal
Congestive Heart Failure
-
8/13/2019 Congestive Heart Failure - Students
54/136
Echocardiogram
-
8/13/2019 Congestive Heart Failure - Students
55/136
Echocardiogram
Differentiate systolic dysfunction
from diastolic dysfunction
Evaluate presence of:
MI, cardiomyopathy,
Left ventricular hypertrophy (LVH),
Valvular disease, etc.
-
8/13/2019 Congestive Heart Failure - Students
56/136
-
8/13/2019 Congestive Heart Failure - Students
57/136
CARDIOMYOPATHY
-
8/13/2019 Congestive Heart Failure - Students
58/136
DILATED HYPERTROPHIC INFILTRATIVE
CARDIOMYOPATHY
Impaired
systolic contraction
Impaired
diastolic relaxation,
vigorous systolic function
Stiff LV
with impaired
diastolic relaxation
CARDIOMYOPATHY
-
8/13/2019 Congestive Heart Failure - Students
59/136
DILATED HYPERTROPHIC INFILTRATIVE
CARDIOMYOPATHY
Impaired
systolic contraction
Impaired
diastolic relaxation,
vigorous systolic function
Stiff LV
with impaired
diastolic relaxation
Dilated,
poorly contracting
LVH,
vigorously contracting
speckled
appearance in
infiltrative disease
ECHO:
-
8/13/2019 Congestive Heart Failure - Students
60/136
Dilated Cardiomyopathy
Alcohol
Beriberi
Coxsackie , Cocaine
Doxorubicin
F irst Aid
-
8/13/2019 Congestive Heart Failure - Students
61/136
Lets look at an Echo
-
8/13/2019 Congestive Heart Failure - Students
62/136
-
8/13/2019 Congestive Heart Failure - Students
63/136
RV
LV
LA
AortaAV
MV
-
8/13/2019 Congestive Heart Failure - Students
64/136
RV
LV
Posterior
Wall
IV
Septum
-
8/13/2019 Congestive Heart Failure - Students
65/136
-
8/13/2019 Congestive Heart Failure - Students
66/136
-
8/13/2019 Congestive Heart Failure - Students
67/136
RV
LV Ao
LA
IV Septum
Posterior wall
-
8/13/2019 Congestive Heart Failure - Students
68/136
DILATED HYPERTROPHIC INFILTRATIVE
LV CAVITY
LV WALL THICKNESS
LV CONTRACLITY
N
N
N
or
or N
-
8/13/2019 Congestive Heart Failure - Students
69/136
How do we treat a patient? ?with CHF
who has
abnormal
systolic function ?
-
8/13/2019 Congestive Heart Failure - Students
70/136
Eliminate precipitating
and aggravating factors
-
8/13/2019 Congestive Heart Failure - Students
71/136
Identify and correct
underlying conditions
-
8/13/2019 Congestive Heart Failure - Students
72/136
Treat acute symptoms
Improve long-term prognosis
-
8/13/2019 Congestive Heart Failure - Students
73/136
Drugs for treating CHF
Diuretics
Inotropics Vasodilators
Beta-blockers
-
8/13/2019 Congestive Heart Failure - Students
74/136
Drugs for treating CHF
Diuretics
Inotropes Vasodilators
Beta-blockers
Diuretic
-
8/13/2019 Congestive Heart Failure - Students
75/136
Diuretic
Di ti
-
8/13/2019 Congestive Heart Failure - Students
76/136
Diuretics
Eliminate Na and H O via kidney Decrease intravascular volume
Decrease preload
Decrease pulmonary and peripheral
edema
Decrease symptoms and signs ofCCF
2+
Diuretics
-
8/13/2019 Congestive Heart Failure - Students
77/136
Diuretics
Side effects Overdiuresis
Electrolyte disturbances
Hypokalemia
Hypomagnesemia
Predispose to
digitalis toxicity
V dil t
-
8/13/2019 Congestive Heart Failure - Students
78/136
Vasodilators
Venous (Nitrates)
Arteriolar (Hydralazine) Balanced (ACE-I)
-
8/13/2019 Congestive Heart Failure - Students
79/136
Spironolactone.
Inotropes. Beta blockers.
MERIT-HF
-
8/13/2019 Congestive Heart Failure - Students
80/136
Gottlieb, S. et al. JAMA 2000;
238:1295-1302.
The Metoprolol Randomized Intervention Trial in
Congestive Heart Failure
LVEF
-
8/13/2019 Congestive Heart Failure - Students
81/136
What effect do
these drugs have onthe Frank - Starling curve?
-
8/13/2019 Congestive Heart Failure - Students
82/136
LV diastolic volumeLV diastolic pressure
normal
STROKEVOLUME
dysfunction
LV EDP
-
8/13/2019 Congestive Heart Failure - Students
83/136
LV EDP
STROKE
VOLUME
dysfunction
PULMONARY
EDEMA
NORMAL
LOWOUTPUT
NORMAL
OUTPUT
NORMALDIASTOLIC
PRESSURE
normal
-
8/13/2019 Congestive Heart Failure - Students
84/136
LVEDP
STROKE
VOLUME
normaldysfunction
PULMONARY
EDEMA
LOWOUTPUT
DIURETICS
-
8/13/2019 Congestive Heart Failure - Students
85/136
LV EDP
STROKE
VOLUME
normaldysfunction
PULMONARY
EDEMA
DIURETICS
LOWOUTPUT
-
8/13/2019 Congestive Heart Failure - Students
86/136
INOTROPES
-
8/13/2019 Congestive Heart Failure - Students
87/136
LV EDP
STROKE
VOLUME
normal
dysfunction
PULMONARY
EDEMA
INOTROPES
LOWOUTPUT
BALANCED VASODILATOR
-
8/13/2019 Congestive Heart Failure - Students
88/136
LVEDP
STROKE
VOLUME
normal
dysfunction
PULMONARY
EDEMA
LOWOUTPUT
BOTH INOTROPES & VASODILATORS
-
8/13/2019 Congestive Heart Failure - Students
89/136
LVEDP
STROKE
VOLUME
normal
dysfunction
PULMONARY
EDEMA
LOWOUTPUT
-
8/13/2019 Congestive Heart Failure - Students
90/136
Does the patient have
NORMAL systolic functionor
ABNORMAL systolic function?
L ft H t F il
-
8/13/2019 Congestive Heart Failure - Students
91/136
Left Heart Failure
SOBOrthopnea
PND
Cardiomegaly
Pulmonary Rales
S3
L ft H t F il
-
8/13/2019 Congestive Heart Failure - Students
92/136
Left Heart Failure
with abnormalsystolic function
Diuretic
DigoxinACE -I
L ft H t F il
but what if patient has ----
-
8/13/2019 Congestive Heart Failure - Students
93/136
Left Heart Failure
with normalsystolic function
Diuretic?
Digoxin?ACE -I?
L ft H t F il
-
8/13/2019 Congestive Heart Failure - Students
94/136
Left Heart Failure
with normalsystolic function
Beta- blocker
NEJM Sept 1999
-
8/13/2019 Congestive Heart Failure - Students
95/136
Aldosterone Blockade WithSpironolactone Reduces Mortality
From Severe CHF
p
Spironolactone (Aldactone)
Improves
Prolongs
R b
-
8/13/2019 Congestive Heart Failure - Students
96/136
Improves
symptoms
Prolongs
lifeDiuretics
DigoxinACE-I
Beta-blockers
+ -
+ -+ +
+ +
Spironolactone + +
Remember
Acute treatment
-
8/13/2019 Congestive Heart Failure - Students
97/136
Acute treatment
O2
MSO4 (increases venous capacitance,
and decreases anxiety)
Diuretic tx
Nitrate tx
-
8/13/2019 Congestive Heart Failure - Students
98/136
Clinical Presentation of
-
8/13/2019 Congestive Heart Failure - Students
99/136
CHF
Treatment Algorithm??
Assess LV function
-
8/13/2019 Congestive Heart Failure - Students
100/136
Assess LV functionby 2-D echo or MUGA
EF > 40%Rx underlying
cause
Diureticsfor congestion
Beta-blockers,
ACE-I
EF < 40%
assess volume status
Signs and symptoms
of fluid retentionNo signs and symptoms
of fluid retention
Diuretic ACE-I
Beta-blocker(low dose)
spironolactone
Hypertension
CHD
-
8/13/2019 Congestive Heart Failure - Students
101/136
Prognosis of Patients with CHF
Depends on etiology
If non-correctable :
~ 50% mortality in 5 years
-
8/13/2019 Congestive Heart Failure - Students
102/136
-
8/13/2019 Congestive Heart Failure - Students
103/136
Left ventricularassist device
New heart
-
8/13/2019 Congestive Heart Failure - Students
104/136
Old
heart
-
8/13/2019 Congestive Heart Failure - Students
105/136
TransplantationEnd-stage heart disease
Severe limits on daily activity
EF < 0.25
Suitable psychosocial profile
Suitable physiologic age
P t T l t
-
8/13/2019 Congestive Heart Failure - Students
106/136
Post Transplant
Survival
1 Year 20% 80%
4 Year 55%
Coronary heart
di
-
8/13/2019 Congestive Heart Failure - Students
107/136
disease
Hypertension
Valvular disease
Congenitalheart disease
Cardio-
myopathy CHF
-
8/13/2019 Congestive Heart Failure - Students
108/136
-
8/13/2019 Congestive Heart Failure - Students
109/136
Cardiomyopathies
-
8/13/2019 Congestive Heart Failure - Students
110/136
Dilated
Hypertrophic
Infiltrative
DILATED HYPERTROPHIC INFILTRATIVE
CARDIOMYOPATHY
-
8/13/2019 Congestive Heart Failure - Students
111/136
DILATED HYPERTROPHIC INFILTRATIVE
DILATED HYPERTROPHIC INFILTRATIVE
CARDIOMYOPATHY
-
8/13/2019 Congestive Heart Failure - Students
112/136
DILATED HYPERTROPHIC INFILTRATIVE
Impaired
systolic contraction
Impaired
diastolic relaxation,
vigorous systolic function
Stiff LV
with impaired
diastolic relaxation
DILATED HYPERTROPHIC INFILTRATIVE
CARDIOMYOPATHY
-
8/13/2019 Congestive Heart Failure - Students
113/136
DILATED HYPERTROPHIC INFILTRATIVE
Impaired
systolic contraction
Impaired
diastolic relaxation,
vigorous systolic function
Stiff LV
with impaired
diastolic relaxation
Dilated,
poorly contracting
LVH,
vigorously contracting
speckled
appearance in
infiltrative disease
ECHO:
Dilated Cardiomyopathy
-
8/13/2019 Congestive Heart Failure - Students
114/136
Dilated Cardiomyopathy
-
8/13/2019 Congestive Heart Failure - Students
115/136
Global Dilatation
Cross-section.
-
8/13/2019 Congestive Heart Failure - Students
116/136
Dilated Cardiomyopathy
-
8/13/2019 Congestive Heart Failure - Students
117/136
Dilated Cardiomyopathy
Alcohol
Beriberi
Coxsackie , Cocaine
Doxorubicin
F irst Aid
Dilated Cardiomyopathy
-
8/13/2019 Congestive Heart Failure - Students
118/136
Dilated Cardiomyopathy
Etiology Idiopathic, alcoholic, myocarditis, post-
partum, doxorubicin, endocrinopathies,
genetic disease, toxins, viruses S/S
Left or BiVentricular CHF
Cardiomegaly, S3, elevated JVP, crackles
Dilated Cardiomyopathy
-
8/13/2019 Congestive Heart Failure - Students
119/136
Dilated Cardiomyopathy
EKG Sinus tachycardia
ST-Tw changes
Conduction abnormalities
Ventricular ectopy
CXR Enlarged heart
Pulmonary venous congestion
Echo
LV dilation & dysfunction Cardiac catherization
LV dilation & dysfunction, high diastolic pressures, low CO
Dilated Cardiomyopathy
-
8/13/2019 Congestive Heart Failure - Students
120/136
Dilated Cardiomyopathy
Treatment ACE-I
BB
Diuretic
Aldosterone antagonist Dig (2ndline)
Sodium restriction
ETOH cessation
Prognosis 11-13% annual mortality
Takotsubo Cardiomyopathy
-
8/13/2019 Congestive Heart Failure - Students
121/136
Takotsubo Cardiomyopathy
LV apical ballooning following highcatecholamine discharge
LV shape similar to octopus pot (takotsubo
pot)
Takotsubo Cardiomyopathy
-
8/13/2019 Congestive Heart Failure - Students
122/136
Takotsubo Cardiomyopathy
Etiology More common in postmenopausal women
Following stressful event (hypoglycemia,
natural disaster, postventricular tachycardia,ETOH withdrawal, post-op, hyperthyroidism,
emotional stress)
S/S
Angina, dyspnea
Takotsubo Cardiomyopathy
-
8/13/2019 Congestive Heart Failure - Students
123/136
Takotsubo Cardiomyopathy
EKG ST elevation
Deep, anterior Tw inversion
CXR Normal or with PVC
Echo
LV apical dyskinesia
Cath
LV apical ballooning, normal coronaries
Takotsubo Cardiomyopathy
-
8/13/2019 Congestive Heart Failure - Students
124/136
Takotsubo Cardiomyopathy
TreatmentASA
BB
ACE-I Tx until LV function recovers
Prognosis
Recovery expected in weeks to months
Hypertrophic Cardiomyopathy
-
8/13/2019 Congestive Heart Failure - Students
125/136
yp p y p y
-
8/13/2019 Congestive Heart Failure - Students
126/136
Hypertrophic Cardiomyopathy
-
8/13/2019 Congestive Heart Failure - Students
127/136
yp p y p y
Etiology Hereditary syndrome (autosomal dominant)
Chronic HTN
S/S
Dyspnea, chest pain, syncope Sustained PMI, S4, variable systolic murmur
(increases with Valsalva, decreases with squatting),bisferiens carotid pulse
Afib (from chronically elevated LA pressures),Ventricular arrhtyhmias, sudden death (esp inathletes post-exertion)
Hypertrophic Cardiomyopathy
-
8/13/2019 Congestive Heart Failure - Students
128/136
yp p y p y
EKG LVH
Exaggerated septal Qw (may be evidence of MI)
CXR Mild cardiomegaly
Echo LVH, asymmetric septal hypertrophy (1.3-1.5X thickness of
posterior wall), small LV, normal/supranormal fxn, systolicanterior motion of mitral valve, mitral regurg, diastolicdysfunction
Cath Small, hypercontractile LV, dynamic outflow gradient, diastolic
dysfunction
Hypertrophic Cardiomyopathy
-
8/13/2019 Congestive Heart Failure - Students
129/136
yp p y p y
Tx BB (slower heart rate assists with diastolic filling of stiff LV) CCB (verapamil)
Disopyramide
Diuretics (2/2 high diastolic pressure and PCWP)
Dual-chamber pacing (to prevent progression of hypertrophy andobstruction)
ETOH septal ablation (injected into septal branches of LCA)
Implantable defibrillator (syncope, family hx of sudden death)
Myotomy-myomectomy (for severe symptoms)
Prognosis variable
Restrictive Cardiomyopathy
-
8/13/2019 Congestive Heart Failure - Students
130/136
y p y
Amyloidosis of the Heart
-
8/13/2019 Congestive Heart Failure - Students
131/136
y
Restrictive Cardiomyopathy
-
8/13/2019 Congestive Heart Failure - Students
132/136
y p y
Etiology Amyloidosis
Hemachromatosis
Sarcoidosis
Connective Tissue disease (scleroderma)
Post-radiation
Post-cardiac surgery
DM
Endomyocardial fibrosis
S/S Dyspnea, fatigue, R-sided CHF
Elevated JVP, Kussmaul sign
-
8/13/2019 Congestive Heart Failure - Students
133/136
Restrictive Cardiomyopathy
-
8/13/2019 Congestive Heart Failure - Students
134/136
y p y
Tx Little useful tx
Diuretics
BB Cardiac transplantation (for primary cardiac
amyloidosis)
Restrictive Cardiomyopathy vs.
Constrictive Pericarditis
-
8/13/2019 Congestive Heart Failure - Students
135/136
Constrictive Pericarditis
Restrictive Elevated pulmonary pressure
Constrictive
Ventricular interaction accentuated withrespiration
-
8/13/2019 Congestive Heart Failure - Students
136/136
Thanks!