Cardiomyopathy

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Author:
Corissa.Stovall
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257398
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Cardiomyopathy
Updated:
2014-01-19 21:29:56
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Path Exam One Spring 2014
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page 7 to 15 CHF powerpoint
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  1. What is the most common cardiomyopathy??
    dilated
  2. What are causes of dilated cardiomyopathy??
    often of unknown cause

    • idiopathic
    • genetic
    • inflammatory --infectious (HIV)
    • toxic (drugs)
    • metabolic (thyroid complications)neuromuscular
  3. What is a common reversible cause of cardiomyopathy??
    acute viral myocarditis
  4. What is the most common indication for heart transplant??
    dilated cardiomyopathy
  5. What is the main problem with dilated cardiomyopathy??
    there is dilation of all the chambers of the heart but the main concern is the LV dilation
  6. What are the main features of dilated cardiomyopathy??
    • dilation of both atria and ventricles
    • thrombi present in LV (bc blood is coagulating here)
    • scarring and dilation of valves
    • decreased systolic function
  7. What are s/s of dilated cardiomyopathy?
    • initially patient will experience s/s of HF
    • CP on exertion that mimics angina
    • ventricular dilation with valve complications (regurg)
    • SVT and V dysrhythmias
    • Sudden death (due to dysrhythmias)
    • Systemic emboli (due to coag in dilated chambers)
  8. What would you expect to see on an EKG of a patient with dilated cardiomyopathy??
    • ST segment and T wave abnormalities
    • LBBB
    • PVCs
    • Afib
  9. What would you expect to see on a chest xray of a patient with dilated cardiomyopathy??
    dilated heart chambers
  10. What would you expect to see on a echo of a patient with dilated cardio myopathy??
    dilation of all four chambers with global hypokinesis (basically means the heart is trying to pump but it's not as effective as normal)
  11. What would you expect to see on a heart cath of patient with dilated cardiomyopathy??
    • increased pulmonary capillary wedge pressure
    • increased SVR
    • Low CO
  12. What is hypertrophic cardiomyopathy??
    left and/or right ventricular hypertrophy, often asymmetrical, which usually involves the interventricular septum
  13. What is the most common genetic cardiovascular disease?
    hypertrophic cardiomyopathy
  14. What are some hemodynamic abnormalities of hypertrophic cardiomyopathy??
    • LV outflow obstruction
    • diastolic dysfunction
    • myocardial ischemia
    • mitral regurg
    • dysrhythmias
  15. What is LVOT obstruction??
    basically on systole, the septum is so enlarged that is will squish the LV and will cause the mitral valve to move forward and block the outflow from the LV during contraction
  16. What are the s/s of hypertrophic  cardiomyopathy??
    • angina
    • fatigue
    • syncope
    • tachydysrhythmias
    • HF

    most patients are asymptomatic most of their life
  17. Why is angina relieved by lying down with patients who have hypertrophic cardiomyopathy??
    bc of the change in the LV size with the change in position.. it will decrease LVOT obstruction
  18. what will an EKG present with hypertrophic cardiomyopathy??
    Lv hypertrophy
  19. What will an echo show on a patient who has hypertrophic cardiomyopathy??
    hypertrophy
  20. What will a patients EF be with hypertrophic cardiomyopathy??
    >80%---hypercontractile heart
  21. What will the results be of a heart cath with a patient with hypertrophic cardiomyopathy??
    increased LVEDP and increased pressure gradients between left ventricle and aorta
  22. What is a definite dx of hypertrophic cardiomyopathy??
    endomyocardial biopsy and analysis
  23. Any drug or event that decreases contractility, increases preload or increases afterload will ____ LVOT.
    improve
  24. During surgery what are 3 things that are bad for patients with LVOT???
    • SNS stimulation
    • decreased volume
    • vasodilation


    all of these cause increased obstruction of LVOT
  25. What symptom during surgery would concern the CRNA that the patient my have undiagnosed HCM?
    unexplained hypotension
  26. What dose of inhalation agents should you give patients with HCM?
    moderate dose---this will produce only a slight decrease in contractility to prevent complications of obstructing LVOT
  27. what should you treat hypotensive patients with in the OR with a hx of HCM?
    phenylephrine

    other drugs are contraindicated bc they will increase contractility and HR to increase BP which increase LVOT obstruction
  28. What symptoms should you prevent postoperatively in patients with HCM?
    • pain
    • shivering
    • hypercapnia
    • anxiety
    • hypoxia

    avoid all factors that would increase SNS activity and cause blockage of outflow

    prompt treatment is CRUCIAL
  29. What is restrictive cardiomyopathy??
    restricted filling and reduced diastolic size of either or both ventricles with normal or near normal systolic function
  30. What is the least common form of cardiomyopathy??
    restrictive cardiomyopathy
  31. What is the cause of restrictive cardiomyopathy??
    it is due to a systemic disease that produces myocardial infiltration and severe diastolic dysfunction
  32. List characteristics of restrictive cardiomyopathy...
    • severe diastolic dysfunction
    • normal systolic function
    • decreased ventricle compliance
    • non dilated ventricles
    • dilated atria
    • fibrotic or infiltrated myocardium
  33. What are two common cause of restrictive cardiomyopathy under the infiltrative classification?? what about under the endomyocardial classification??
    amyloid and sarcoid

    radiation and chemo toxicity
  34. What are hallmarks of restrictive cardiomyopathy??
    s/s of HF with mostly R sided findings

    normal L and R ventricular size and systolic function with DILATED ATRIA

    diastolic ventricular functional abnormalitites suggestive of reduced ventricular compliance or stiffness

    AFIB IS COMMON

    Heart block or dysrhythmias develop overtime
  35. how can you determine the cause of restrictive cardiomyopathy??
    endomyocardial biopsy
  36. How should you manage restrictive cardiomyopathy in the OR?
    • prevent fluid overload
    • maintain NSR and avoid decrease in HR
    • maintain vascular volume and venous return to maintain CO
  37. 28 year old man with history of dyspnea on exertion for 2 years and recent palpitations. echo shows normal EF with septal thickening.  Holter reveals frequent PVCs.. what kind of cardiomyopathy is this??
    hypertrophic
  38. 55 year old female with recent viral illness.  progressive SOB, orthopnea and PND.  CXR shows vascular congestion.  Echo with 4 chamber dilation and EF 15%.  what kind of cardiomyopathy is this??
    dilated
  39. 43 year old female with Hodkins lymphoma treated with radiation and chemo.  Presents with worsening SOB, weight gain, and fatigue.  Echo reveals normal size ventricles with biatrial dilation.  What kind of cardiomyopathy is this??
    restrictive
  40. What is cor pulmonale??
    the most important factor in this process is chronic alveolar hypoxia.  Chronic hypoxia from COPD, a restrictive disease or respiratory insufficiency causes pulmonary vasoconstriction.  Vasoconstriction leads to pulmonary hypertension.  HTN leads to remodeling and increased PVR.  Pulmonary HTN causes increased workload of the right ventricle and hypertrophy of the ventricle occurs overtime..


    So basically you have right ventricle enlargement due to pulmonary HTN that can progress to right sided HF
  41. What are s/s of cor pulmonale??
    • peripheral edema
    • if r sided failure --- dyspnea, JVD, hepatosplenomegaly
  42. What will an EKG show with Cor Pulmonale??
    • possible R sided hypertrophy
    • peaked P waves in II,III and AVF
    • Right axis deviation and RBBB
  43. What can an Echo show you with Cor pulmonale??
    it can tell you the estimate of pulmonary artery pressure as well as the size and function of the right atrium and ventricle

    can also tell you of tricuspid or pulmonic valve regurg
  44. What are the treatment goals with cor pulmonale??
    • reduce the workload of the right side of the heart
    • decrease PVR  and pulmonary artery pressure

    supplement O2 to maintain Pao2 >60

    use diuretic and dig if right sided heart failure does not respond to treatment of hypoxia
  45. What kind of anesthesia do you use with a patient with cor pulmonale??
    whatever you want as long as the patient is deep enough to prevent bronchospams
  46. Why are volatile anesthetics good with cor pulmonale??
    they are bronchodilators
  47. Why should you avoid opoids with cor pulmonale??
    respiratory depression
  48. Why should high levels of blocks be avoided with cor pulmonale??
    the patient can lose the ability to use their accessory muscle to aid with breathing leading to further complications

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