🫀Cardiovascular System

Cardiomyopathy

Dilated Cardiomyopathy

  • Etiology
    • Left ventricular dilation, impaired contractility (systolic dysfunction), decreased EF
    • Most commonly idiopathic. Secondary causes are genetic and myocarditis (most commonly), as well as alcohol, postpartum, endocrinopathies, drugs, infection, nutritional disorders. Most common secondary causes are genetic and due to myocarditis.
  • Signs/Symptoms
    • Symptoms of systolic CHF
    • Symptoms - exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, peripheral edema
    • PE - JVD, S3/S4 gallop, mitral/tricuspid systolic murmur (mitral/tricuspid regurgitation), displacement of left ventricular impulse
  • Diagnosis
    • Diagnosis is made with echocardiogram, which shows an enlarged, balloon-like heart +/- pulmonary congestion
  • Treatment
    • Address the underlying cause
    • Same as systolic heart failure
      • ACE/ARB and beta-blockers prevent heart remodeling and decrease mortality (class II - IV)
      • Aldosterone antagonists (class III - IV) decreases mortality
      • Hydralazine/Nitrates (class II - IV)
      • Diuretics for volume overload
      • Digoxin
      • Implantable cardioverter defibrillator if EF <35%
      • Biventricular pacemaker

Hypertrophic Cardiomyopathy

  • Etiology
    • Thickened ventricular walls, impaired relaxation, decreased filling
    • Most commonly genetic. Hypertrophic obstructive cardiomyopathy (HOCM) is autosomal dominant and most common cause of sudden death in young and healthy athletes. Secondary causes are hypertension, aortic stenosis.
  • Signs/Symptoms
    • Symptoms of diastolic CHF
    • Symptoms - Most commonly asymptomatic, however when symptoms are present they are dyspnea, syncope, palpitations, angina
    • PE - systolic ejection crescendo-decrescendo murmur that increases as preload decreases (with Valsalva maneuver or standing), sustained apical impulse, S4 gallop
  • Diagnosis
    • Diagnosis is made by echocardiogram, which shows thickened inter ventricular septum, left ventricular outflow tract obstruction
    • ECG - left ventricular hypertrophy
  • Treatment
    • First line - Beta-blocker (especially useful with obstruction)
    • Second line - Verapamil if BB is not effective or contraindicated
    • Disopyramide
    • Diuretics can be used if there is no obstruction (contraindicated with obstruction)
    • Implantable defibrillator
    • Ablation of septum or surgical myectomy for HOCM patients with persistent symptoms
    • Avoid intense exercise

Restrictive Cardiomyopathy

  • Etiology
    • Decreased elasticity, impaired filling (diastolic dysfunction)
    • Most commonly idiopathic. Most common identifiable causes are due to fibrosis (scarring, radiation, amyloidosis (amyloid protein buildup), sarcoidosis (granuloma infiltration), hemochromatosis (iron deposits).
  • Signs/Symptoms
    • Symptoms of right-sided heart failure
    • PE - JVD, peripheral edema, Kussmaul sign
  • Diagnosis
    • Diagnosis is made by echocardiogram, which shows decreased movement of myocardium, rapid early filling, normal EF
    • Cardiac biopsy - fibrosis, evidence of infiltration
  • Treatment
    • Address the underlying etiology (usually palliative)
    • For symptom control, diuretics for fluid overload and vasodilators to decrease filling pressure

Conduction Disorders/Dysrhythmias

Bradyarrhythmias and Conduction Abnormalities

Sinus Bradycardia
  • Etiology
  • Signs/Symptoms
  • Diagnosis
  • Treatment
Sinus Block (SA Node Block)
  • Etiology
  • Signs/Symptoms
  • Diagnosis
  • Treatment
Sick Sinus Syndrome
  • Etiology
  • Signs/Symptoms
  • Diagnosis
  • Treatment
Sinus Arrhythmia
  • Etiology
  • Signs/Symptoms
  • Diagnosis
  • Treatment
Atrioventricular Block
First-Degree AV Block
  • Etiology
  • Signs/Symptoms
  • Diagnosis
  • Treatment
Second-Degree AV Block - Type 1 (Wenckebach)
  • Etiology
  • Signs/Symptoms
  • Diagnosis
  • Treatment
Second-Degree AV Block - Type 2 (Mobitz)
  • Etiology
  • Signs/Symptoms
  • Diagnosis
  • Treatment
Third-Degree AV Block
  • Etiology
  • Signs/Symptoms
  • Diagnosis
  • Treatment
Right Bundle Branch Block
  • Etiology
  • Signs/Symptoms
  • Diagnosis
  • Treatment
Left Bundle Branch Block
  • Etiology
  • Signs/Symptoms
  • Diagnosis
  • Treatment
Premature Beats

PACs/PVCs
  • Etiology
  • Signs/Symptoms
  • Diagnosis
  • Treatment
Supraventricular Tachyarrhythmias

Sinus Tachycardia
  • Etiology
  • Signs/Symptoms
  • Diagnosis
  • Treatment
Atrial Fibrillation
  • Etiology
  • Signs/Symptoms
  • Diagnosis
  • Treatment
Atrial Flutter
  • Etiology
  • Signs/Symptoms
  • Diagnosis
  • Treatment
Supraventricular Tachycardia
  • Etiology
  • Signs/Symptoms
  • Diagnosis
  • Treatment
Ventricular Tachyarrhythmias

Wolff-Parkinson-White Syndrome
  • Etiology
  • Signs/Symptoms
  • Diagnosis
  • Treatment
Ventricular Tachycardia
  • Etiology
  • Signs/Symptoms
  • Diagnosis
  • Treatment
Ventricular Fibrillation
  • Etiology
  • Signs/Symptoms
  • Diagnosis
  • Treatment
Torsades de pointes
  • Etiology
  • Signs/Symptoms
  • Diagnosis
  • Treatment

Congenital Heart Disease

Atrial septal defect
Coarctation of aorta
Patent ductus arteriosus
Tetralogy of Fallot
Ventricular septal defect

Coronary artery disease

Acute myocardial infarction
o Non–ST-segmentelevation
o ST-segmentelevation
Angina pectoris
o Prinzmetal variant
o Stable
o Unstable

Heart failure

Hypertension

Essential hypertension
Hypertensive emergencies
Secondary hypertension

Hypotension

Cardiogenic shock
Orthostatic hypotension
Vasovagal hypotension

Lipid disorders

Hypercholesterolemia
Hypertriglyceridemia

Traumatic, infectious, and inflammatory heart conditions

Acute and subacute bacterial endocarditis
Acute pericarditis
Cardiac tamponade
Pericardial effusion

Valvular disorders

Aortic
Mitral
Pulmonary
Tricuspid

Vascular disease

Aortic aneurysm/dissection
Arterial embolism/thrombosis
Arteriovenous malformation
Giant cell arteritis
Peripheral artery disease
Phlebitis/thrombophlebitis
Varicose veins
Venous insufficiency
Venous thrombosis