PANCE Blueprint Cardiology (13%)

Cardiomyopathy (PEARLS)

The NCCPA™ PANCE Cardiology System Content Blueprint includes 3 different types of cardiomyopathy

Types of cardiomyopathy

  • Dilated cardiomyopathy: ventricles enlarge and weaken - inherited in about one-third of cases,  may also result from alcohol, heavy metals, coronary artery disease, cocaine use, and viral infections.
  • Hypertrophic cardiomyopathy: the heart muscle enlarges and thickens - inherited autosomal dominant -
  • Restrictive cardiomyopathy: ventricle stiffens - may be caused by amyloidosis, hemochromatosis, and some cancer treatments
  • Arrhythmogenic right ventricular dysplasia (ARVD): fatty replacement of myocardium - genetic defect
  • Takotsubo cardiomyopathy (broken heart syndrome): non-ischemic cardiomyopathy in which there is a sudden temporary weakening of the muscular portion of the heart -extreme emotional or physical stress
Major categories of cardiomyopathy
Impaired Systolic Function
Dilated Cardiomyopathy Dilated cardiomyopathy is the most common type (95%) of cardiomyopathy and is a condition in which an index event or process (such as an MI) damages the myocardium, weakening the heart muscle resulting in reduced strength of ventricular contraction, and dilation of the left ventricle.

  • Reduced contraction strength, large heart
  • Etiology: caused by Ischemia (CAD, MI, arrhythmia), genetics, excess alcohol, postpartum, chemotherapy, endocrine disorders, viral infections, cocaine use, heavy metals
    • Inherited in 1/3 of cases
  • Physical exam: Dyspnea, S3 gallop, rales, jugular venous distention - systolic heart failure

Blausen 0165 Cardiomyopathy Dilated

Treatment:

  • Abstain from alcohol
  • Medications: ACE inhibitors, diuretics
Impaired Diastolic Function
Hypertrophic Obstructive Cardiomyopathy (HOCM) Hypertrophic portion of septum - LV outflow tract is narrowed - during systole and obstruction worsened with increased contractility

Blausen 0166 Cardiomyopathy Hypertrophic

Presentation: Young athlete with a positive family history has sudden death or syncopal episode

  • Inherited autosomal dominant
  • Presents in early adulthood
  • Not to be confused with hypertrophy of elite athlete
  • Screen family members

Physical Exam:

  • Sustained PMI, bifid pulse, S4 gallop
  • Murmur: High pitched mid-systolic murmur at LLSB. Increased with Valsalva and standing (less blood
    in the chamber).

    • Decreased with squatting (more blood in the chamber)
    • Increased with Valsalva or standing

Treatment:

  • Refrain from vigorous physical activity
  • Medical: Beta-blockers or calcium channel blockers
  • Surgical: Surgical or alcohol ablation of hypertrophied septum and defibrillator insertion
Restrictive Cardiomyopathy Right heart failure with a history of an infiltrative process

Etiology: Amyloidosis, sarcoidosis, hemochromatosis, scleroderma, fibrosis, and cancer

Physical Exam:

  • Pulmonary HTN present
  • Normal ejection fraction, normal heart size, large atria, normal left ventricular wall, early diastolic filling

Treatment: Non-specific. Diuretics, ACE inhibitors, Calcium channel blockers

EKG Pearls and Pitfalls (video) (Prev Lesson)
(Next Lesson) Brian Wallace PA-C Podcast: Cardiomyopathies and Hypertension
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