Cardiomyopathy (main)

Dilated Cardiomyopathy

Background

• Idiopathic form accounts for 25% of CHF

Diagnosis

• CHF symptoms
• CXR
  • Cardiomegaly, pulm venous htn
• ECG
  • LV hypertrophy, poor R wave progression

Treatment

• Similar to CHF exacerbation
• Ensure exacerbation not due to ischemia

Hypertrophic Cardiomyopathy

Background

• "HOCM"
• Abnormal LV diastolic function due to decr compliance

Diagnosis

• Exertional dyspnea, chest pain, syncope
• Systolic murmur that increases w/ valsalva
• ECG
  • LV hypertrophy, deep Qs in 1, avL, V5-6 (daggers of death)

Treatment

• If decompensated presents as hypotensive CHF
  • Preserve preload
    • Careful hydration
    • Avoid high airway pressure if intubate
  • Limit tachycardia
    • Beta blockers
  • Avoid vasodilators (no nitrates)
  • Maintain sinus rythm (i.e. cardiovert A. fib)
  • Increase afterload (hypotensive only)
    • Phenylephrine

Restrictive Cardiomyopathy

Background

• Must distinguish from constrictive pericarditis

Diagnosis

• Consider if CHF but no e/o cardiomegaly or systolic dysfunction

Treatment

• Symptom directed (diuretics and ACEI)

See Also

• Peripartum Cardiomyopathy

Source

Tintinalli