(精编)【医学精品英文课件】心肌病 Heart Muscle Disease- Cardiomyopathy教学课件.pptVIP

Heart Muscle Disease:Cardiomyopathy Laura Wexler, M.D. 558-5575 wexlerl@ucmail.uc.edu Case A 56 year old man comes to your office complaining of three months of progressive fatigue and dyspnea on exertion. Several times in the past month he has awakened from sleep with severe breathlessness and felt a need to sit up in order to breath. He denies any chest pain or pressure. He also has noticed some ankle swelling. He has no past medical history of heart disease, hypertension or diabetes. His family history is negative for heart disease. He does not smoke and drinks alcohol only rarely. He takes no medications. Physical Exam BP 105/70, P 98 regular, T 98.6?, RR 20 Carotids are low volume with normal upstroke. JVP elevated: 10 cm above the sternal angle. Lungs: Bibasilar rales. Heart: PMI diffuse, palpable at the anterior axillary line. S1 diminished intensity, S2 normal, S3 is present. 2/6 holosystolic murmur at the apex. Abdomen: Liver is enlarged (span 11 cm) and slightly tender to pressure. Positive hepatojugular reflex (+HJR). No ascites. Extremities: Mild edema of both feet and ankles. Dilated Cardiomyopathy Dilation of one or both ventricles Globally impaired ventricular systolic function: both ventricles or predominantly the left ventricle. Isolated RV cardiomyopathy is rare. Systolic heart failure Etiology of dilated cardiomyopathy Coronary artery disease Idiopathic Hypertensive heart disease Familial/genetic Viral/other infectious agents (HIV) Immune/autoimmune Alcoholic/toxic (cocaine, chemotherapeutic drugs) Infiltrative (hemochromatosis, sarcoidosis, amyloidosis) Post partum Natural History of Dilated Cardiomyopathy Congestive heart failure Arrhythmias (Afib, VT) Sudden death Thromboembolism Chest pain Diagnosis of Dilated Cardiomyopathy Exclude other causes of contractile failure (HTN, CAD, valvular disease). Test for specific etiologies ?Percutaneous endomyocardial biopsy Goals of Therapy in Dilated Cardiomyopat