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IM - DISEASES OF THE HEART M USCLE

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tonystep1's version from 2017-08-26 09:22

CAUSES

Question Answer
Dilated Cardiomyopathya. Toxic: Alcohol, doxorubicin, Adriamycin
b. Metabolic: thiamine or selenium deficiency, hypophosphatemia, uremia
c. Infectious: viral, Chagas' disease, Lyme disease, HIV
d. Thyroid disease: hyperthyroidism or hypothyroidism
e. Peripartum cardiomyopathy
f. Collagen vascular disease: SLE, scleroderma
g. Prolonged, uncontrolled tachycardia
h. Catecholamine-induced: pheochromocytoma, cocaine
i. Familial genetic
j. Idiopathic
Hypertrophic Cardiomyopathy (HCM)Most cases are inherited as an autosomal dominant trait. However, spontaneous
mutations may account for some cases
Restrictive Cardiomyopathyl. Amyloidosis
2. Sarcoidosis
3. Hemochromatosis
4. Scleroderma
5. Carcinoid syndrome
6. Idiopathic
Myocarditispossible causes, including viruses (e.g. , Coxsackie B) , bacteria (e.g., group A streptococcus in rheumatic fever, Lyme disease, mycoplasma, and so on) , SLE, medications (e.g., sulfonamides); can also be idiopathic
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CLINICAL FEATURES AND DIAGNOSIS

Question Answer
Dilated CardiomyopathySymptoms and signs of left- and right-sided CHF develop // s3. s4. and murmurs of mitral or tricuspid insufficiency may be present // ECG, CXR, and echocardiogram results consistent with CHF
Hypertrophic Cardiomyopathy (HCM)Dyspnea on exertion // sudden death // Systolic ejection murmur Intensity increases with Valsalva and standing (decreases LV size and thus decreases left ventricular filling) // Decreases with sustained handgrip (increased systemic resistance leads to decreased gradient across aortic valve) // Echocardiogram establishes the diagnosis
Restrictive CardiomyopathyElevated filling pressures cause dyspnea and exercise intolerance // Right-sided signs and symptoms are present for the same reason. // Echo - Thickened myocardium and possible systolic ventricular dysfunction // Increased right atrium (RA) and left atrium (LA) size with normal LV and RV size
MyocarditisMay be asymptomatic, or may present with fatigue, fever, chest pain, pericarditis, CHF, or even death // Look for elevations in cardiac enzyme levels and erythrocyte sedimentation rate.
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TREATMENT AND MANAGEMENT

Question Answer
Dilated CardiomyopathySimilar to treatment of CHF: digoxin, diuretics, vasodilators, and cardiac
transplantation
Remove the offending agent if possible
Anticoagulation should be considered because patients are at increased risk of
embolization
Hypertrophic Cardiomyopathy (HCM)All patients should avoid strenuous exercise
Beta-Blockers should be the initial drug used in symptomatic patients
Calcium channel blockers (verapamil) used if unresponsive to Beta Blockers
Diuretics can be used if fluid retention occurs.
Myomectomy has a high success rate for relieving symptoms. It involves the
excision of part of the myocardial septum. It is reserved for patients with
severe disease.
Restrictive CardiomyopathyTreat underlying disorder
Use diuretics and vasodilators (for pulmonary and peripheral edema) cautiously,
because a decrease in preload may compromise cardiac output.
MyocarditisTreatment is supportive. Treat underlying causes if possible, and treat any complications
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