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2014-01-19 17:57:35

patho test 1
Show Answers:

  1. What is the most common cardiomyopathy??
  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??
  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 decreases afterload will ____ LVOT.
  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?

    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


    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