Cardiology #1 – Myopathies

Episode 1 – Dilated, Restrictive, and Hypertrophic Obstructive Cardiomyopathy.

Hot Points:

Dilated: systolic failure, thinning and weakening of the ventricles, low EF

* most common form by far

* defined as EF <40%

* likely hx: ETOH, HIV+, Hep C, ischemic disease / previous MI (but here’s a more comprehensive list of Causes)

* 50% of cases idiopathic, no cause found

* Mitral & Tricuspid Regurg. usually present.

* Tx w/ diuretics,

Restrictive: diastolic failure, filling problem, normal EF

* stiff fibrotic ventricular walls of normal size,

* usually caused by Amyloidosis or Sarcoidosis

* increased diastolic pressure leading to back up into the lungs.

* MUST DDx from Restrictive Pericarditis

* Tx w/ Beta Blockers or Ca++ Blockers to lower rate and increase filling time, pacemaker, transplant.

*

Hypertrophic: diastolic failure, LV thickening of wall and septum

* septum thickening leads to outflow obstruction

* usually genetically inherited (autosomal dominant)

* Murmur of HOCM increases with valsalva –> decreases preload, increases outflow obstruction of septum.

* Classic presentation is high school athlete or teenager

* Tx w/ Beta Blockers or Ca++ Blockers to reduce work of the heart