Dilated cardiomyopathy (dcm) ✅most common
•cardiac muscle fiber damage; interferes with myocardial metabolism
•increased ventricular chamber size with normal or decreased muscle size; left ventricle
commonly larger than right.
•contractility in left ventricle decrease - results in decreased stroke volume and cardiac
output (impaired systolic function)
•ventricle continues to enlarge without adjustments in venous return or peripheral
vascular resistance
Lv gets so big, losing pressure and cannot push out
Dilated cardiomyopathy s/s ✅(can be asymptomatic for months to years )
•early:
•tachycardia
•dry cough at night
•dyspnea on exertion
•weakness
•variable degrees of cardiomegaly
•late:
•heart failure (left side most common)
•dysrhythmia or heart block
•systemic or pulmonary emboli
,•shortness of breath
•orthopnea
•peripheral edema
•hepatomegaly
•jugular vein distension
•weight gain
•systolic murmur (s3 and s4 gallop)
Dilated cardiomyopathy treatment ✅•permanent atrioventricular sequential pacer
implementation
•icd
•heart transplant
•cardiac mems
•medication management
•vasodilators
•antiarrhythmics for rhythm control
•ace inhibitors
•diuretics (loop)
•ionotropic medications
•symptomatic treatment of heart failure
•lifestyle modifications
•sodium and fluid restriction
Hypertrophic cardiomyopathy ✅•asymmetrical ventricular hypertrophy and disarray of
the myocardial fibers
•primarily effects diastolic function (filling)
•increased pulmonary vascular resistance
•mitral insufficiency
•failure of left ventricle relaxation (diastole) = decreased/slowed filling
•thickening interventricular septum = obstructed blood flow to aortic valve
•small coronary arteries are unable to supply sufficient blood resulting in ischemia and
angina
•approx. ½ patients carry single-gene autosomal- dominant trait
Biggest problem is filling in lv
Cannot fully fill, ef might be normal but you need to look further, muscle is swollen
Inherited
Coronary arteries gets filled during diastolic (heart gets fed)
, •pulse irregularities
•ventricular dysrhythmias
•systolic ejection murmur heard along left sternal boarder and cardiac apex (s4 gallop)
Hypertrophic cardiomyopathy treatment ✅•surgery - ventricular myomectomy,
percutaneous alcohol septal ablation; muscle resection with mitral valve replacement
•ventricular myomectomy - removal of a portion of the hypertrophied ventricular septum
•percutaneous alcohol septal ablation - causes small septal infarct reducing blood
supply and thus inhibiting the continuous septal hypertrophy (growth)
•conversion of atrial fibrillation
•icd
•medication for symptom management
•beta-adrenergic blocking agents (carvedilol)
•calcium antagonists (verapamil)
•diuretics
•ace inhibitors
Restrictive cardiomyopathy ✅•decreased ventricular chamber size due to thickening
•decreased cardiac output with high diastolic pressure in comparison to diastolic volume
•enlarged atria due to thickened ventricular wall = atrial fibrillation
•slow diastolic filling
•increased left ventricular hypertrophy
•ventricular rigidity due to fibrosis - impairs contraction during systole
•incompetent atrioventricular valves
•symptoms similar to those of left and right sided heart failure
Slow diastolic filling, less space in lv, muscle is stiff, hard for it to pump out to arteries
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