PANCE Blueprint Cardiology (13%)

Cardiomyopathy (PEARLS)

The NCCPA™ PANCE Cardiology System Content Blueprint includes 3 different types 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
  • Physical exam: Dyspnea, S3 gallop, rales, jugular venous distention - systolic heart failure

 

Dilated Cardiomyopathy

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

 

Hypertrophic Cardiomyopathy

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 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 infiltrative process Restrictive Cardiomyopathy

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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