Cardiomyopathy
Progressive impairment of the structure and function of the muscular walls of the heart chambers
Best way to see if a patinet has cardiomyopathy: Echocardiogram
Usually happens as a result of another problem- too much resistance and the heart starts to give out
Hypertrophic Cardiomyopathy
Hypertrophic-
- Diastolic dysfunction
- Risk of sudden death in young athletes
- Thickened left ventricular wall
- Common in athletes
includes heart disorders in which the walls of the ventricles thicken and become stiff, even though the workload of the heart is not increased
Common in athletes, some are born with it, May accompany, acromegaly (Too much GH) or pheochromocytoma, could be a tumor, May be congenital
Hardly any blood can go into the ventricle causing less output
4% die
S/S: Fainting, SOB, Palpitations
Treatment: Beta blockers, Calcium channel blockers, if pituitary problem fix the pituitary, pheochromocytoma-fix it, Surgically remove part of the muscle
Dilated Cardiomyopathy
- Enlargement of all cardiac chambers
- Systolic dysfunction
- Most common type
- Group of heart muscle disorders in which the ventricles enlarge but are not able to pump enough blood for the body needs, resulting in heart failure. Cannot forcefully pump the blood out to the body. Part of the heart tissue dies and there is scar tissue in between fibers of the muscle.
- Usually happens because of CAD, but can also happen because of infection in your heart, hormone disorders, too much alcohol, malnutrition. Can develop at any age (20-60 is common). Occurs more frequently in black men.
PC –eventually get cardiomegaly (enlarged heart)
S/S
- SOB
- Tired Easily
- If started with infection: would look something like the flu
- B/P will be normal or low
- HR elevated
- Edema of legs, abdomen, and lungs
- Heart will be enlarged
- Leaky valves
- Could have arrhythmias
- Pooled blood leading to baby clots meaning I could shoot off an embolism
Treatment: Coumadin, beta blockers, ace inhibitors, digoxin, and transplant
Restrictive Cardiomyopathy
- Rigid ventricular walls
- Diastolic dysfunction
- Least Common Type
includes a group of heart disorders in which the walls of the heart become stiff, but not necessarily thickened and resist the normal filling with blood between contractions
- Lining won’t expand
- Type a = lining replaced with
scar tissue: due to infection - Type b – muscle is in-
filtrated with abnormal
substances - The use of steroids, and decreased iron or bleeding might have an impact
- 70% die within 5 years
S/S: SOB, Chest pain, Fainting
Treatment: Make them comfortable, most of the drugs we can give probably won’t work, probably will try Digoxin, can do a transplant
Management of Cardiomyopathies
Medical Management is directed toward determining and managing possible underlying or precipitating causes
Surgical Management: Left ventricular outflow tract surgery Take out some of the muscle Heart transplantation Mechanical assist devices and total artificial hearts
Infectious Diseases of the Heart
Any layer of the heart can become infected
Infections are named by the layer affected:
Endocarditis- inside layer
Pericarditis- outside layer
Myocarditis- muscle layer
Diagnosis is made by symptoms, echo and blood cultures, EKG, Echo, Cardiac caths, physical assessment
Infective Endocarditis
An infection of the lining of the heart (endocardium) and usually also the heart valves.
- Vegetative growths occur and may embolize to tissues throughout the body.
- Occurs most often in men over 60
- Vegetative growth- if lettuce was white, can break off and go anywhere into the body like an embolis
- ***Acute – rapid onset and life threatening within days, high temp 102-104, tachycardia, super tired, extensive valve damage
- ***Subacute – gradual subtle onset, comes in over weeks or months. Start getting more and more tired and going downhill. Fever of 99-101, tired, tachycardia, weight loss, sweating, anemia.
- Usually develops in people with prosthetic heart valves or structural cardiac defects. Also occurs in patients who are IV drug abusers and in those with debilitating diseases, indwelling catheters, or prolonged IV therapy, gingivitis
S/S: Join pain, Chills, Painful nodules that pop up, Pticiai, Splinter hemorrhages
- Diagnosis: Echocardiogram
- Treated with antibiotics for 2-6 weeks, may have to go in and repair valves
- PC: blocks arteries, abscesses, clots, sepsis (setpic shock)
Infective Pericarditis
Inflammation of the pericardium that begins suddenly, is often painful and causes build up of fluid and blood components such a fibrin (pericardial effusion), RBCs and WBCs to pour into the pericardial space
Fluid from pericardium puts pressure on heart–> Pressure prevents expansion and filling–> Less blood leaves the heart–> Little O2 reaches tissues–> Tachycardia, rapid fall in b/p, tachypnea, panic, jugular distention–> Loss of consciousness and sudden death
Treatment: Antibiotics
PC:
Pericardial effusion
- Pain, cough, dyspnea, tachycardia, hoarseness hiccups, all worse when lying down
Cardiac Tamponade
- Chest pain to the left shoulder, anxious, confused, distended jugulars, decreased systolic BP, when you listen to heart and lungs will hear a rub
- Treatment: Needs goes in to relive pressure- doctor does this
PC from HIV, tuberculosis
Infective Myocarditis
Focal or diffuse inflammation of the heart muscle
Strep throat can mess with the heart, valves, musculature.
If we damage all or part of the muscle, will impair pumping action
Results in
- Cardiac dysfunction
- Dilated cardiomyopathy
***Careful use of dioxin – can become toxic- Look up SE of Digixon toxicity- yellow halo, N&V, visual disturbances
Treatment:
Treatment is with appropriate antimicrobial therapy.
Rest
NSAIDS
Steroids
Pericardiocentesis- needle into the heart to relieve pressure (centesis- take fluid out) if necessary
Antibiotic prophylaxis
Patients need to be instructed to complete the course of appropriate antimicrobial therapy, and require teaching about infection prevention and health promotion.
Rheumatic Endocarditis
- Occurs most often in school-age children, after group A beta-hemolytic streptococcal pharyngitis
- Comes from Rheumatic fever
- Injury to heart tissue is caused by inflammatory or sensitivity reaction to the streptococci.
- Myocardial and pericardial tissue is also affected, but endocarditis results in permanent changes in the valves.
- Need to promptly recognize and treat “strep” throat to prevent rheumatic fever.
S/S: Sore throat (first) Joint pain Fever Palpitations Chest pain Skin nodules (rheumatic fever)
Antibiotic Prophylaxis
- Mechanical valve replacements including annuloplasty or other prosthetic material
- Valvular defects including mitral click and murmur or mitral regurgitation, mitral stenosis, aortic stenosis, and aortic regurgitation
- A history of rheumatic heart disease, endocarditis, or myocarditis
- ***Antibiotic prophylaxis is required for dental procedures and surgical interventions, including GU and GI procedures, to prevent endocarditis.
