lecture 25 brickner
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| disorder of heart muscle characterized by diastolic dysfunction but nl systolic ventricular function | restrictive cardiomyopathy, least common type of cardiomyopathy
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| most common causes of restrictive cardiomyopathy | amyloidosis, sarcoidosis and hemochromatosis
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| presentation of restrictive cardiomyopathy | predominantly R-sided failure due to elevated right atrial and ventricular pressures. sx: fatigue, DOE, peripheral edema, maybe heart block or a-fib too
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| what causes DOE in restrictive cardiomyopathy? | low cardiac output NOT pulmonary sequela. right heart is overfilled and typically doesn't push lots of vol out into the lungs = no pulmonary vascular congestion
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| PEx of pt with R heart failure | JVD, hepatomegaly, abd girth increase, RUQ pain, nausea, peripheral edema, inspiratory increase in jugular venous distension (Kussmaul sign)
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| clinical course of pt with restrictive cardiomyopathy | very poor prog usually 1-2 yrs after dx, death from low output heart failure, heart block, a-fib and its complications or refractory ventricular arrhythmias
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| CXR and EKG of pt with restrictive cardiomyopathy | CXR: possible CM, but usually nl sized heart, possible pleural effusions // EKG: low voltage, AV and rhythm disturbances are common
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| Echo results of pt with restrictive cardiomyopathy | all chamber diastolic pressures are elevated and equal with prominent y descent from rapid atrial emptying, square root sign or dip and plateau on ventricular pressure tracing
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| constrictive pericarditis | pericardium is thickened and fibrotic resulting in restriction of heart during diastole. think heart is in a concrete shell that won't let it expand
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| common etiologies for constrictive pericarditis | most commonly idiopathic, TB, viral, remote bacterial/fungal/parasitic infection, SLE or RA, irradiation, malignangy of pericardium or prev surg
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| presentation of pt with constrictive pericarditis | insidious onset of abd swelling from ascites, peripheral edema, fatigue, dyspnea from diminished CO. possible vague abd discomfort or nonspecific retrosternal CP
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| PEx of pt with restrictive pericarditis | almost same as with restrictive cardiomyopathy EXCEPT at the apex there should be a pericardial knock as well as Kussmaul's sign
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| tx of restrictive pericarditis | milder cases may be treated with diuretics. those who failed medical tx may need total pericardectomy
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| radiographic finding diagnostic for restrictive pericarditis | presence of pericardial calcification on CXR or pericardial thickening on MRI/CT
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| etiologies of acute pericarditis | typically idiopathic, following AMI, infectious process, blunt or sharp trauma to the chest, uremia, invasion of adj tumor, irradiation, surg or med-related
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| presentation of pt with acute pericarditis | sharp retrosternal CP that is classically worsened with deep inspiration or when lying supine but improved by sitting hunched over, dyspnea, cough, hoarseness or dysphagia
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| diagnostic tests for acute pericardiits | diffuse ST elevation pattern on ECG, CXR showing pericardial effusion, pericardial friction rub on exam, serum Cr to r/o uremic pericarditis
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| tx of acute pericarditis | go after the underlying cause if there is enough evidence to support one. o/w give ASA/NSAIDs to relieve pain/inflammation and effusion will resolve within days-wks
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| pericardial tamponade | life-threatening complication of pericardial inflammation where effusion pressure inside pericardial sac begins to compromise heart function
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| pulsus paradoxus | seen with pericardial tamponade. with inspiration the right heart fills and left side is underfilled with drop in SBP felt as softer pulse pressure distally
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| clinical signs of pericardial tamponade | decreased BP or narrow pulse presure, inc HR and RR, inc JVP, pulsus paradoxus
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| Echo findings of pt with pericardial tamponade | collapsed RV during diastole or equalization of diastolic pressures in R sided chambers of heart
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| EKG findings of pt with pericardial tamponade | diffuse ST segment elevation, low voltage, electrical alternans (each QRS height is alternating in size) due to heart swinging back in forth within pericardial fluid
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