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Lecture 17

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NURS 203
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Lecture 17 Cardiomyopathies Large left ventricle and right ventricle Congestive cardiomyopathy (aka dilated cardiomyopathy) – Example: woman 6 weeks postpartum, and do a chest x-ray and she has a generalized cardiomegaly – heart is huge, has effusions at both lung bases – dx? Congestive cardiomyopathy; this is a dz of the cardiac muscle and has many causes. Pt has both left and right heart failure. Causes: 6 weeks postpartum (don’t know why), Coxsackie’s myocarditis, alcohol, drugs; MCC transplants is due to congestive cardiomyopathy. Cardiotoxic drugs – daunorubicin, tricyclics = drug induced cardiomyopathies = congestive cardiomyopathy. Alcoholic with big heart due to thiamine def = congestive cardiomyopathy. Hypertrophic cardiomyopathy MCC sudden death in a young athlete = hypertrophic cardiomyopathy. Thickness of septum very thick with an asymmetric HPY; why? B/c the interventricular septum is thicker. Blood flow of left vent – goes through narrow opening (ant leaflet of mitral valve – so, if you have aortic regurg, blood will hit anterior leaflet of mitral valve and produce Austin flint murmur). Why is this a narrow opening? B/c it is too thick. If we took a laser to burn it off, could open it up; so, where is the obstruction in hypertrophic cardiomyopathy? Its not at the level of the aortic valve, but below it. Why does it obstruct? Venturi phenomenon – things go through a narrow opening quickly and there is a negative pressure behind it. When blood, under increased force of contraction is forced through, the negative pressure behind it sucks the anterior leaflet behind the septum and stops the blood, leading to obstruction of blood flow. What can we do to make this better (what can we do to reduce the intensity of the murmur and have the pt have better CO)? Put more blood into the ventricle – increase preload and decrease obstruction b/c it would pull it away b/c there is more blood in it. All these things that increase preload will make the intensity of the murmur less and improve the pt. So, if you are standing up, will that improve the dz? No, b/c would decrease preload, leading to a hars
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