醫學筆記匯整 ED Notes

* Cardiomyopathy 定義 : 
   先排除因為 HTN, CAD, VHD or congenital heart disease
   等原因所造成的次發性心肌病變

DCM : 壁薄, 四腔室擴大 , Systolic dysfunction
 

HCM : 不對稱中膈肥厚 (中膈/後壁>1.3) 
              LV 變超小 , Diastolic dysfunction
              Gene(AD), mitral valve SAM => LVOT obstruction
              beta blocker, CCB
 

RCM : 壁變硬,  Diastolic dysfunction, Infiltrative, Treat reason
 

*** SAM 示意圖 ***

HOCM 特色 : 

1. Systolic anterior motion (SAM) of the mitral valve
    and dynamic left ventricular outflow tract (LVOT) obstruction
2. Asymmetrical thickening of the anterior interventricular septum
   (Asymmetrical septal hypertrophy)

 

• DCM : CHF symptoms
• HCM : Syncope, Sudden death
• RCM : DOE, Fatigue 

* HCM EKG :

   - Deep, narrow (dagger-like)“Septal Q waves” in the lateral and sometimes inferior leads
     (Due to the abnormally hypertrophied interventricular septum)
     下壁 + 外側壁 --- > Q wave 

   - LVH

   - 大 R 波  lead T inv 

   - Sometimes associated with WPW
   - P mitrale (LAE) : Left ventricular diastolic dysfunction
 

HCM :
 - Exertional syncope or pre-syncope
    suggesting dynamic LVOT obstruction ± ventricular dysrhythmia,
    with the potential for sudden cardiac death.
 - Symptoms of pulmonary congestion due to left ventricular dysfunction
   (exertional dyspnoea, fatigue, orthopnoea, paroxysmal nocturnal dyspnoea)
   
 - Chest pain may be typical anginal pain due to increased demand (thicker myocardial walls)
   and reduced supply (aberrant coronary arteries).

 - Palpitations due to supraventricular or ventricular arrhythmias.
 

* HCM : 

* DCM : 

* HCM Mamagement :
- Restriction of physical activity ( 只能輕度中度有氧運動 )
- Implantable cardioverter-defibrillators ( ICD )
- Nonpharmacologictreatment of LVOT obstruction
- Medical treatment : Beta-blocker, CCB 
- Catheter ablation

* 水多水少?
    回心血流增加 : 蹲姿, 肌肉收縮, 吸氣 (胸內負壓增加->靜脈回流增加)
    回心血流減少 : 站姿, valsava maneuver, 吐氣