8/5/2023 0 Comments Narrow pulse pressure![]() Clinical presentationĬHF signs and symptoms develop as the cardiac output decreases. Myocardial fibrosis may lead to ventricular arrhythmias secondary to the development of reentry circuits in the ventricles. The blood flow to kidneys is diminished with resultant salt and water retention and worsening of CHF. Systolic dysfunction is manifested by decreased shortening and ejection fractions which leads to increased end-diastolic volume and pressure. Histologically, there is myocyte hypertrophy and degeneration and interstitial fibrosis as compared to myocarditis, in which there is myocyte necrosis and lymphocytic infiltration. The myocardium is pale and mottled and the endocardium is thin. The heart in dilated cardiomyopathy is globular and is grossly dilated. Autosomal recessive, X-linked and mitochondrial inheritance have also been described. In familial cases, an autosomal dominant transmission is the most frequent pattern of inheritance. It may be secondary to myocarditis, coronary artery disease, and many other conditions. This is the most common cause of cardiomyopathy in children. Restrictive cardiomyopathy - which is characterized by primary diastolic dysfunction, normal ventricular size and dilated atria.HOCM is characterized by ventricular hypertrophy (usually asymmetric) with normal systolic function but abnormal diastolic function. Hypertrophic obstructive cardiomyopathy (HOCM) - also known as idiopathic hypertrophic sub aortic stenosis.Dilated cardiomyopathy (DCM) - in which the left ventricle is dilated and has poor systolic function.Cardiomyopathies are usually classified as follows: Quick Checks - Kawasaki Disease, Endocarditis, Rheumatic feverĬardiomyopathies & Myocarditis CardiomyopathiesĬardiomyopathy is defined as a structural or functional abnormality of the myocardium that is not secondary to structural heart disease, hypertension, or pulmonary vascular disease.General treatment of the acute episode:.Antimicrobial prophylaxis: (2007 AHA guidelines).Classic KD is diagnosed by the following criteria:. ![]() Kawasaki Disease (Mucocutaneous Lymph Node Syndrome).Premature ventricular contractions (PVCs).Hypertrophic Obstructive Cardiomyopathy.Ebstein Anomaly of the Tricuspid Valve (EA).Pulmonary Atresia with Intact Ventricular Septum (PA-IVS).Clinical presentation, EKG and, imaging.Total Anomalous Pulmonary Venous Connection (TAPVC).Corrected Transposition of the Great Arteries (L-TGA).Complete Transposition of the Great Arteries (D-TGA).Systolic Murmur Grades based on the intensity of the murmur.The backward flow of blood into the LA during ventricular systole results in a holosystolic murmur. This remodeling helps to limit the increases in LA and LV pressures. In long-standing or chronic mitral regurgitation, the left atrium adapts to the larger volume by dilating, which increases its compliance. In acute mitral regurgitation (e.g., after sudden rupture of the chordae tendineae ), the atrial pressure can become very elevated. If the volume of blood ejected into the aorta is sufficiently reduced, then aortic pressure may fall (110/75 mmHg in this example). Although the LV stroke volume (end-diastolic minus end-systolic volume) is increased, the net amount of blood ejected into the aorta is reduced because part of the LV stroke volume (regurgitant fraction) is also ejected into the LA. This increase in LV preload causes the LV to contract more forcefully ( Frank-Starling mechanism ), which enables it to increase its stroke volume. During LV filling, the higher pressure and volume of the LA leads to an increase in LV end-diastolic pressure (25 mmHg in this example) and LV end-diastolic volume. This causes LA pressure to increase (25 mmHg in this example). This causes the left atrium to be become engorged with blood because blood is entering the LA from the LV during ventricular systole as well as from the pulmonary veins. Mitral valve regurgitation occurs when the mitral valve fails to close completely during ventricular systole, which causes blood to flow back (regurgitate) into the left atrium (LA) as the left ventricle (LV) contracts (see figure at right). The narrowed pulse pressure is for severe MR: Here's a good description from cvphysiology ( Disease/HD005).
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