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What is the most common cardiomyopathy??
What are causes of dilated cardiomyopathy??
often of unknown cause
- inflammatory --infectious (HIV)
- toxic (drugs)
- metabolic (thyroid complications)neuromuscular
What is a common reversible cause of cardiomyopathy??
acute viral myocarditis
What is the most common indication for heart transplant??
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
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
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)
What would you expect to see on an EKG of a patient with dilated cardiomyopathy??
- ST segment and T wave abnormalities
What would you expect to see on a chest xray of a patient with dilated cardiomyopathy??
dilated heart chambers
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)
What would you expect to see on a heart cath of patient with dilated cardiomyopathy??
- increased pulmonary capillary wedge pressure
- increased SVR
- Low CO
What is hypertrophic cardiomyopathy??
left and/or right ventricular hypertrophy, often asymmetrical, which usually involves the interventricular septum
What is the most common genetic cardiovascular disease?
What are some hemodynamic abnormalities of hypertrophic cardiomyopathy??
- LV outflow obstruction
- diastolic dysfunction
- myocardial ischemia
- mitral regurg
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
What are the s/s of hypertrophic cardiomyopathy??
most patients are asymptomatic most of their life
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
what will an EKG present with hypertrophic cardiomyopathy??
What will an echo show on a patient who has hypertrophic cardiomyopathy??
What will a patients EF be with hypertrophic cardiomyopathy??
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
What is a definite dx of hypertrophic cardiomyopathy??
endomyocardial biopsy and analysis
Any drug or event that decreases contractility, increases preload or decreases afterload will ____ LVOT.
During surgery what are 3 things that are bad for patients with LVOT???
- SNS stimulation
- decreased volume
all of these cause increased obstruction of LVOT
What symptom during surgery would concern the CRNA that the patient my have undiagnosed HCM?
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
what should you treat hypotensive patients with in the OR with a hx of HCM?
other drugs are contraindicated bc they will increase contractility and HR to increase BP which increase LVOT obstruction
What symptoms should you prevent postoperatively in patients with HCM?
avoid all factors that would increase SNS activity and cause blockage of outflow
prompt treatment is CRUCIAL
What is restrictive cardiomyopathy??
restricted filling and reduced diastolic size of either or both ventricles with normal or near normal systolic function
What is the least common form of cardiomyopathy??
What is the cause of restrictive cardiomyopathy??
it is due to a systemic disease that produces myocardial infiltration and severe diastolic dysfunction
List characteristics of restrictive cardiomyopathy...
- severe diastolic dysfunction
- normal systolic function
- decreased ventricle compliance
- non dilated ventricles
- dilated atria
- fibrotic or infiltrated myocardium
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
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
how can you determine the cause of restrictive cardiomyopathy??
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
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