1
What is the best way to diagnose cardiomyopathy? What is the medical treatment?
1. Dx with ECHO, possibly early screen with ultrasound
2. Rx with AICD (defibrillator), heart transplant
- Inflammation of the pericardium
- Most common issue encountered by PTs will be associated with connective tissue diseases, post MI, renal failure, after open heart surgery, radiation therapy
Pericarditis
Major myocardial disorder due to insufficient blood supply causing ischemia
Arteriosclerosis (hardening of the arteries) is the primary cause; Atherosclerosis (plaque buildup) is the primary form of arteriosclerosis
Often asymptomatic until arterial intima blocked >75% (can be more)
Coronary artery disease (CAD)
Which type of cardiomyopathy: Rigid walls (chambers)
- unable to stretch/fill properly (preload issue - Rsided CHF-like)
- L atrium enlarges (push back into lungs)
- Ventricular scar impairs fill/ decreased SV/EF
- Least common of the three
Restrictive
Accumulated fluid within the pericardial sac which can be caused by any blunt force trauma or any acute pericarditis
Pericardial effusion
s/s: Pain can be MSK problem with upper back, neck, or upper trap pain. Pain may be diminished by holding breath, aggravated by coughing, neck or trunk movements (especially R side bending)
Pericarditis
Which type of cardiomyopathy: Thickened LV
- Increase HR; resistance to fill drastic preload issue; systolic murmur increased with valsalva; asymptomatic til death; autosomal dominant; sudden, cardiac arrest
Hypertrophy ***
What are the symptoms of cardiomyopathy?
Often the same as heart failure
What is the clinical sign of pericarditis?
Pericardial rub
Initially symptom improvement, then stabilization, ultimately death from heart failure or sudden death
Prognosis for cardiomyopathy
Which type of cardiomyopathy: Enlarged LV
- Frank Sterling law ( + and -)
- Increased EDV causes afterload issue
- TV/MV regurg = A fib risk (L or R sided CHF symptoms)
- SV = decreased EF and CO with time (EX: SOB and edema)
- MOST COMMON OF THE THREE
Dilated
- Conditions intrinsic to the heart muscle itself (EX: contraction and relaxation of the muscle fibers)
- cause is usually unknown, genetics
- Excludes: structural and functional abnormalities (EX: vascular disorders, CAD, HTN, congenital defects, and pulmonary vascular disorders)
Cardiomyopathy
It is the thickening of the inner arterial walls (intima) with lipid deposits, smooth muscle cells and macrophages (WBC= bring inflammation), which forms plaque
Atherosclerosis
Which race is the most prevalent for CAD?
Caucasian
Why is CAD more prevalent in men until their 50's and then by 60's the women begin the surpass the men in these numbers?
Because women hit menopause and there is a drop in estrogen levels which keep LDL levels down. With this loss, we have a rise in LDL levels and a drop in HDL levels
Protects vessel wall
- Injury triggers thrombolytic process
- infiltration of macromolecules
- Platelet adherence to point of clot formation
Normal endothelium in atherosclerosis
What is a modifiable factor in cardiac disease?
Cholesterol
What is the type of atherosclerosis that is NON-MODIFIABLE; autosomal recessive or dominant; 50/50 chance of getting this; extremely high LDL levels; STATINS DO NOT WORK FOR THIS CONDITION
Familial Hypercholesterolemia **
(Inflammation)
- fatty streaks consist of WBC, LDL, particles, smooth muscle cells, and platelets
Early injury during atherosclerosis
- Platelets proliferate, adhere to arterial wall
- Thrombus break-off (embolus)
Late effects of atherosclerosis
- Falls under the term: Peripheral vascular disease (PVD)
- Linked with HTN, smoking, DM and hyperlipidemia
- Associated with increased risk of death and ischemic events
- Up to 50% of patients are asymptomatic **
- Often underdx/undx by doctors
Peripheral arterial disease (PAD)
Microvascular occlusion of the arteries throughout the body over time (usually due to cholesterol plaque= in the toes)
Thromboangiitis obliterans
Exercise increases pain. Sitting relieves the pain
Claudication
- Common cause of disability and QOL decreases
- Besides atherosclerosis, other causes are trauma, vasculitis, vasomotor disorders and thrombus/embolism
- EX: thromboangiitis obliterans (plaque throughout multiple arteries)
Arterial occlusive disorders
- A fib; HTN; PE; rheumatic heart disease; DM; ischemia/hemorrhage
- Acute arterial emboli --> MEDICAL EMERGENCY
- Risks: stroke, MI, amputation, death
- Medical management often involves thrombectomy, follwed by aspirin and antiplatelet regimen
- s/s: cold foot, purple color
Arterial embolism causes