Restrictive cardiomyopathy resident survival guide: Difference between revisions

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:❑  Medication
:❑  Medication
❑&nbsp;&nbsp;Diet(restriction of sodium and fluid intake?)</div>}}
❑&nbsp;&nbsp;Diet(restriction of sodium and fluid intake?)</div>}}
{{familytree | | | | | | | | G01 |G01=<div style="text-align: left;"><b><u>Physical examination:</u></b><br>}}
{{familytree | | | | | | | | G01 |G01=<div style="text-align: left;"><b><u>Physical examination:</u></b><br>
❑&nbsp;&nbsp;Vital signs:
 
:❑&nbsp;&nbsp;Pulse (strength and regularity)
:❑&nbsp;&nbsp;Blood pressure
 
:❑&nbsp;&nbsp;Respiratory rate
❑&nbsp;&nbsp;General appearance:
:❑&nbsp;&nbsp;BMI(weight loss/weight gain)
 
:❑&nbsp;&nbsp;Peripheral edema
 
:❑&nbsp;&nbsp;[[JVD]] may show severity of hemodynamic impairment, most prominent wave is the y descent, jugular venous pulse doesn't fall during inspiration (Kussmaul's sign)
 
❑&nbsp;&nbsp;Heart:
 
:❑&nbsp;&nbsp;First heart sound is usually normal, and the second heart sound is split normally,
 
:❑&nbsp;&nbsp;Carotid and peripheral pulses may show evidence of a low output
❑&nbsp;&nbsp;Lungs:
:❑&nbsp;&nbsp;Rales?
:❑&nbsp;&nbsp;Pleural effusion?
❑&nbsp;&nbsp;Abdomen:
 
:❑&nbsp;&nbsp;[[Hepatomegaly]], pulsatile liver and/or [[ascites]] (volume overload)
❑&nbsp;&nbsp;Extremities:
:❑&nbsp;&nbsp;Temperature of lower extremities</div>}}
 
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{{familytree | | | | | | | | H01 |H01=A01}}
{{familytree | | | | | | | | I01 |I01=A01}}     
{{familytree | | | | | | | | I01 |I01=A01}}     

Revision as of 19:47, 9 March 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Steven Bellm, M.D. [2]

Restrictive cardiomyopathy resident survival guide Microchapters
Overview
Classification
Causes
FIRE
Diagnosis
Treatment
Do's
Dont's

Overview

Restrictive cardiomyopathy is defined as heart-muscle disease with impaired ventricular filling usually due to increased stiffness. The diastolic volume of either or both ventricles is normal or decreased,the systolic function usually remains normal and wall thickness may be normal or increased. The symptoms and signs may consist of right (jugular venous pressure, peripheral edema, and ascites) or left ventricular failure (breathlessness and evidence of pulmonary edema).[1]


Classification

 
 
 
 
 
 
 
Restrictive cardiomyopathy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Myocardial
 
 
 
 
 
 
 
Endomyocardial
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Nininfiltrative
 
InfiltrativeStorage Disease
 
 
 
 
 

Causes

Common Causes

Complete Diagnostic Approach

A complete diagnostic approach should be carried out after a focused initial rapid evaluation is conducted and following initiation of any urgent intervention.

 
 
 
 
 
 
 
History and symptoms:

❑  Hints for etiology ❑  Duration and onset of illness/symptoms ❑  Severity and triggers of dyspnea/orthopnea and fatigue/weakness, presence of chest pain, exercise capacity, physical activity, sexual activity (NYHA?), ❑  Weight loss/weight gain (cachexia/volume overload?) ❑  Palpitations/(pre)syncope/ventricular tachycardias/cardiac arrest or fibrillation ❑  Symptoms of transient ischemic attack or thromboembolism (anticoagulation necessary?) ❑  Presence of peripheral edema or ascites (volume overload?) ❑  Problems with breathing at night/ sleep ❑  Medical history

❑  Prior hospitalizations
❑  Medication
❑  Diet(restriction of sodium and fluid intake?)
 
 
 
 
 
 
 
Physical examination:

❑  Vital signs:

❑  Pulse (strength and regularity)
❑  Blood pressure
❑  Respiratory rate

❑  General appearance:

❑  BMI(weight loss/weight gain)
❑  Peripheral edema
❑  JVD may show severity of hemodynamic impairment, most prominent wave is the y descent, jugular venous pulse doesn't fall during inspiration (Kussmaul's sign)

❑  Heart:

❑  First heart sound is usually normal, and the second heart sound is split normally,
❑  Carotid and peripheral pulses may show evidence of a low output

❑  Lungs:

❑  Rales?
❑  Pleural effusion?

❑  Abdomen:

❑  Hepatomegaly, pulsatile liver and/or ascites (volume overload)

❑  Extremities:

❑  Temperature of lower extremities
 
 
 
 
 
 
 
A01
 
 
 
 
 
 
 
A01
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
B01
 
 
 
 
 
 
 
B02
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
C01
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
D01
 
D02
 
 
 
 
 
D03
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
E01
 
 
 
 
 
 
E02
 
 
E03
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
F01
 
 
F02

Treatment

shown

hidden

Do's

Dont's

References

  1. Kushwaha SS, Fallon JT, Fuster V (1997). "Restrictive cardiomyopathy". N Engl J Med. 336 (4): 267–76. doi:10.1056/NEJM199701233360407. PMID 8995091.