Restrictive cardiomyopathy resident survival guide: Difference between revisions

Jump to navigation Jump to search
No edit summary
No edit summary
Line 95: Line 95:
{{familytree | | | | | | | | I01 |I01=<div style="text-align: left;"><b><u>Imaging and additional tests:</u></b><br>
{{familytree | | | | | | | | I01 |I01=<div style="text-align: left;"><b><u>Imaging and additional tests:</u></b><br>
❑&nbsp;&nbsp;<b>Noninvasive imaging and tests:</b>
❑&nbsp;&nbsp;<b>Noninvasive imaging and tests:</b>
:❑&nbsp;&nbsp;ECG:  
:❑&nbsp;&nbsp;<u>ECG:</u>
::❑&nbsp;&nbsp;Non-specific ST- and T-wave abnormalities
::❑&nbsp;&nbsp;Non-specific ST- and T-wave abnormalities
::❑&nbsp;&nbsp;Eventually Depolarization abnormalities: Such as bundle-branch or ventricular hypertrophy, or abnormalities of conduction, including atrioventricular block
::❑&nbsp;&nbsp;Eventually Depolarization abnormalities: Such as bundle-branch or ventricular hypertrophy, or abnormalities of conduction, including atrioventricular block
:❑&nbsp;&nbsp;Chest x-ray: Cardiac size is usually normal, atrial enlargement, pulmonary congestion, interstitial edema with Kerley B lines, pleural effusions?
:❑&nbsp;&nbsp;<u>Chest x-ray:</u> Cardiac size is usually normal, atrial enlargement, pulmonary congestion, interstitial edema with Kerley B lines, pleural effusions?
:❑&nbsp;&nbsp;2D echocardiography with Doppler:
:❑&nbsp;&nbsp;<u>2D echocardiography with Doppler:</u>
::❑&nbsp;&nbsp;Pattern of mitral-inflow velocity: increased early diastolic filling velocity (>1.0 m per second)/ decreased atrial filling velocity (<0.5 m per second)/ increased ratio of early diastolic filling to atrial filling (>2)/ decreased deceleration time (<150 msec)/ decreased isovolumic relaxation time (<70 msec)  
::❑&nbsp;&nbsp;Pattern of mitral-inflow velocity: increased early diastolic filling velocity (>1.0 m per second)/ decreased atrial filling velocity (<0.5 m per second)/ increased ratio of early diastolic filling to atrial filling (>2)/ decreased deceleration time (<150 msec)/ decreased isovolumic relaxation time (<70 msec)  
::❑&nbsp;&nbsp;Pulmonary-vein or hepatic-vein flow: systolic forward flow is less than diastolic forward flow/ increased reversal of diastolic flow after atrial contraction with inspiration in the hepatic and pulmonary veins
::❑&nbsp;&nbsp;Pulmonary-vein or hepatic-vein flow: systolic forward flow is less than diastolic forward flow/ increased reversal of diastolic flow after atrial contraction with inspiration in the hepatic and pulmonary veins
::❑&nbsp;&nbsp;shortened deceleration time across the mitral and tricuspid valves </div>}}     
::❑&nbsp;&nbsp;shortened deceleration time across the mitral and tricuspid valves
 
❑&nbsp;&nbsp;<b>Invasive imaging and tests:</b>
 
:❑&nbsp;&nbsp;<u>Cardiac catheterization</u></div>}}     
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}
{{familytree | | | B01 | | | | | | | | B02 | | |B01=B01|B02=B02}}
{{familytree | | | B01 | | | | | | | | B02 | | |B01=B01|B02=B02}}

Revision as of 20:29, 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
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
 
 
 
 
 
 
 
Laboratory findings:

❑  Complete blood count
❑  Chemistry:

❑  Troponin, BNP or NT-proBNP
❑  Serum electrolytes (including calcium and magnesium)
❑  Blood urea nitrogen
❑  Serum creatinine
❑  Glucose
❑  Fasting lipid profile
❑  Liver function tests
❑  Thyroid-stimulating hormone
❑  Consider Screening for hemochromatosis, HIV, rheumatologic diseases, amyloidosis, sarcoidosis
 
 
 
 
 
 
 
Imaging and additional tests:

❑  Noninvasive imaging and tests:

❑  ECG:
❑  Non-specific ST- and T-wave abnormalities
❑  Eventually Depolarization abnormalities: Such as bundle-branch or ventricular hypertrophy, or abnormalities of conduction, including atrioventricular block
❑  Chest x-ray: Cardiac size is usually normal, atrial enlargement, pulmonary congestion, interstitial edema with Kerley B lines, pleural effusions?
❑  2D echocardiography with Doppler:
❑  Pattern of mitral-inflow velocity: increased early diastolic filling velocity (>1.0 m per second)/ decreased atrial filling velocity (<0.5 m per second)/ increased ratio of early diastolic filling to atrial filling (>2)/ decreased deceleration time (<150 msec)/ decreased isovolumic relaxation time (<70 msec)
❑  Pulmonary-vein or hepatic-vein flow: systolic forward flow is less than diastolic forward flow/ increased reversal of diastolic flow after atrial contraction with inspiration in the hepatic and pulmonary veins
❑  shortened deceleration time across the mitral and tricuspid valves

❑  Invasive imaging and tests:

❑  Cardiac catheterization
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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.