1. Cardiovascular Blueprint PANCE Blueprint

2. Dilated Cardiomyopathy Defined as being characterized by enlargement of chambers and impaired systolic function. Can involved one or both ventricles

3. Dilated Cardiomyopathy Causes -Genetic -Thyrotoxicosis -Metabolic (Starvation) -Peri or Post partum -Cobalt ingestion

4. Dilated Cardiomyopathy -Sarcoidosis -Hemochromatosis -Radiation -Thiamine Deficiency -Alcohol -Catecholamine induced -Infectious (Viral and Parasitic) -Radiation

5. Dilated Cardiomyopathy Big Picture-can be idiopathic but can be caused by ingestion of toxins, radiation, infection, or metabolic disorders -Physical Exam similar to a patient with heart failure -EKG may show some LVH or RVH -ECHO is necessary for diagnosis -Cardiac biopsy only for those who may have treatable cause -Treatment is similar to heart failure targeted at increasing preload and decreasing after load. -ACE inhibitors and Beta Blockers are ideal for those patients who can tolerate them

6. Hypertrophic Cardiomyopathy Has normal or small left ventricle size Involves a disproportionate thickening of the inter- ventricular septum Causes outflow obstruction and diastolic disfunction Mainly an autosomal dominant cause Can cause life threatening arrhythmias

7. Hypertrophic Cardiomyopathy Can be asymptomatic Most common symptom is dyspnea on exertion May have exertion chest pain from outflow obstruction rather than coronary artery disease Syncope or dizziness may be present can cause life threatening arrhythmias

8. Hypertrophic Cardiomyopathy Can be asymptomatic Most common symptom is dyspnea on exertion May have exertion chest pain from outflow obstruction rather than coronary artery disease Syncope or dizziness may be present Physical Findings-crescendo-decrescendo systolic murmur S4 gallop from increased ventricular stiffness

9. Hypertrophic Cardiomyopathy Can hear an S3 if left ventricular systolic problems ECHO is needed for diagnostic confirmation and to determine the severity May need cath to rule out concomitant coronary artery disease Treatment is targeted at improving diastolic disfunction Calcium channel blockers are ideal Beta blockers can be used to These increase preload and allow the ventricle to fill better

10. Restrictive Cardiomyopathy Has a small ventricle size May involve one or two ventricles Characterized by diastolic dysfunction Elevated ventricular filling pressures Systolic function normal Most common causes is amyloidosis Can be idiopathic Can be caused by Sarcoidosis, Hemochromatosis, Radiation, scleroderma, Gaucher’s disease

11. Restrictive Cardiomyopathy Physical exam-signs of right heart failure are present Elevated right side heart pressures and dilated neck veins ECHO is needed in the diagnosis Right heart cath sometimes needed to make sure it is not constrictive pericarditis Treatment is similar to heart failure Diuretics help decrease systemic vascular resistance

12. Cardiomyopathy Summary Dilated Cardiomyopathy-systolic dysfunction, may affect one or both ventricles. Symptoms similar to CHF. Dilated chambers Hypertrophic Cardiomyopathy-diastolic problem, small chambers can cause outflow obstruction. Can cause DOE or chest pain with activity Restrictive Cardiomyopathy-diastolic problem, elevated right heart pressures, amyloidosis most common cause, treatment similar to heart failure