Cardiomyopathy
What are the types of cardiomyopathy?Give 1 example of each
1. Systolic and Diastolic dysfunction (e.g
Dilated cardiomyopathy and myocarditis)
2. Diastolic Dysfunction (e.g HCOM, restrictive cardiomyopathies)
what is the classic pain describe with pericarditis ?
Typically, chest pain is most severe when the patient is supine and is relieved when the patient sits up and leans forward.
what is HTN Emergency ?
Hypertensive emergency is a hypertensive crisis (systolic blood pressure >180 mm Hg and/or diastolic blood pressure >120 mm Hg) with concomitant end-organ damage; the targeted end organs include the brain, heart, aorta, kidneys, or eyes.
Classification
Stanford classification considers any involvement of the ascending aorta a type A dissection. Stanford type B dissections are restricted to only the descending aorta.
Risk factor Mycotic aneurysms and infected aneurysms
IV drug abuse
What causes chest pain in HCOM?
Chest pain in hypertrophic cardiomyopathy patients is due to an imbalance between the oxygen demand of the hypertrophied left ventricle and the available myocardial blood flow
Five causes of pericarditis
Idiopathic
• Infectious, Viral, Bacterial, Fungal (especially Histoplasma capsulatum)
• Malignancy (leukemia, lymphoma, metastatic breast and lung carcinoma, melanoma)
• Drug induced (procainamide, hydralazine)
• Systemic rheumatic diseases
• Radiation induced
• Post myocardial infarction (Dressler’s syndrome)
• Uremia
• Myxedema
Most common symptom of pulmonary hypertension present in over 50% of patients.
dyspnea
M/c presentation of a Dissection
Classically, dissection presents with abrupt5 and severe pain5 in the chest that radiates to an area between the scapulae and may be accompanied by a feeling of impending doom
what is my management?
> 3.0 cm
>5.0 cm
An abdominal aortic aneurysm is defined as an aorta ≥3.0 cm in diameter; repair is considered for an aneurysm ≥5.0 cm in diameter
What are common symptoms of dilated cardiomyopathy?
As a result of systolic pump failure, the patient presents with signs and symptoms of heart failure: dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, bibasilar rales, and dependent edema.
EKG findings in a patient with acute Pericarditis
Diffuse STE (not meeting criteria for a STEMI) with PR depression in avR
Late findings in patients with pulmonary HTN
RV failure (e.g., a holosystolic tricuspid regurgitation murmur, jugular venous distention, hepatomegaly, ascites and lower extremity edema
P/E findings ? Pulse and BP
Pulse deficit in radial arteries or femoral arteries may be found (15%).
A blood pressure difference >20 mm Hg
Classic triad?
M/C presenting complaint
The classic triad of a ruptured abdominal aortic aneurysm—abdominal pain, pulsatile abdominal mass, and hypotension
Many patients present with nonclassic sites of pain, such as the flank, groin, isolated quadrants of the abdomen, and hip
What are the treatment options for cardiomyopathy?
DCOM: medical therapy and heart transplantation
HCOM: Beta-blockers
The gold standard for diagnosis of myocarditis is?
Endocardial biopsy
M/C EKG and ultrasound findings of pulmonary HTN
EKG: right axis deviation
U/S: right atrial enlargement and dilated IVC
Other than a CT scan what imagining maybe both sensitive and specific
Transesophageal echocardiography may be as sensitive and specific as CT.
A history of aortic graft placement with large amounts of GI bleeding
Aortoenteric fistulas
How can you confirm the Diagnosis of HCOM?
cardiac MRI or echocardiography.
Pericarditis vs myocarditis : 1 similarity & 1 difference
chest pain and post viral
troponin severely evelated without signs of ischemia
Vent settings for a patient with pulmonary HTN
Ventilator settings:
• low airway pressure
•Lung-protective settings (6 to 8 mL/kg)
•lowest positive end-expiratory pressure to maintain the oxygen saturation >90%)
•target a plateau pressure of <30 cm H2O
• increase respiratory rate to avoid hypercapnia (can increase pulmonary vascular resistance, pulmonary artery pressure, and RV strain)
Target HR and BP
HR< 60bpm
BP<120/80 (permissive Hypotension
Sign of a ruptured AAA
Cullen and grey turner sign