Lecture Cardio Physiotherapy 2

7/30/2019 Lecture Cardio Physiotherapy 2

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Valvular HeartValvular Heart

DiseaseDisease


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Heart ValvesHeart Valves


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Valvular StenosisValvular Stenosis

the valve opening narrowsthe valve opening narrows

the valve leaflets may become fused or thickened that thethe valve leaflets may become fused or thickened that the

valve cannot open freelyvalve cannot open freely obstructs the normal flow ofobstructs the normal flow ofbloodblood

EFFECTS: the chamber behind the stenotic valve is subject toEFFECTS: the chamber behind the stenotic valve is subject to

greater stressgreater stress must generate more pressure ormust generate more pressure orworkwork

hardhard to force blood through the narrowed openingto force blood through the narrowed opening

initially, the compensates for the additional workload byinitially, the compensates for the additional workload by

gradual hypertrophy and dilation of the myocardiumgradual hypertrophy and dilation of the myocardium heart failureheart failure


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Valvular Insufficiency orValvular Insufficiency or

RegurgitationRegurgitation scarring and retraction of valve leaflets or weakening ofscarring and retraction of valve leaflets or weakening of

supporting structuressupporting structures incomplete closure of the valveincomplete closure of the valve

result toresult to leakage or backflow of bloodleaka

ge or backflow of blood from the previousfrom the previouschamberchamber

EFFECTS: causes the to pump the same blood twice (as theEFFECTS: causes the to pump the same blood twice (as the

blood comes back into the chamber)blood comes back into the chamber)

the dilates to accommodate more blood (the usualthe dilates to accommodate more blood (the usualbloodblood

it needs to pump + regurgitated blood)it needs to pump + regurgitated blood) ventricular dilation and hypertrophyventricular dilation and hypertrophy eventually leadseventually leads

toto

heart failureheart failure


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CAUSES OF VALVULARCAUSES OF VALVULAR

DISORDERSDISORDERS

Congenital heart diseaseCongenital heart disease Rheumatic heart diseaseRheumatic heart disease Heart attack damage to the heart muscle, papillary musclesHeart attack damage to the heart muscle, papillary muscles Weakening of supporting structures of the heartWeakening of supporting structures of the heart

Weakening of the heart muscleWeakening of the heart muscle Infections bacterial endocarditisInfections bacterial endocarditis


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Mitral StenosisMitral Stenosis

most commonmost common valvularvalvulardisorderdisorder

in rheumatic feverin rheumatic fever

may also be caused bymay also be caused bybacterialbacterial

infection, thrombusinfection, thrombus

formation, calcificationformation, calcification

obstruct blood flow from leftobstruct blood flow from left

atrium to the left ventricleatrium to the left ventricle


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MitralMitral

StenosiStenosi

ss


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PATHOPHYSIOLOGYPATHOPHYSIOLOGY

Narrowing of mitralvalve

CO

O2/CO2 exchange(fatigue, dyspnea,

orthopnea)

Left

ventricularatrophy

pulmonarycongestion

pulmonarypressure

left atrialpressure

Hypertrophyleft atrium

blood flowto left

ventricle

Right-sidedfailure

Fatigue


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CLINICALCLINICAL

MANIFESTATIONSMANIFESTATIONS exertional dyspneaexertional dyspnea andand fatiguefatigue (most common)(most common) orthopnea, paroxysmal nocturnal dyspnea, cough,orthopnea, paroxysmal nocturnal dyspnea, cough,

hemoptysishemoptysis

cyanosiscyanosis Right-sided heart failure distended neck veins,Right-sided heart failure distended neck veins,

peripheral edema, hepatomegaly, abdominal discomfortperipheral edema, hepatomegaly, abdominal discomfort

Auscultation:Auscultation: diastolic murmur (apex)diastolic murmur (apex) CXR- left atrial enlargementCXR- left atrial enlargement

ECG atrial fibrillation may develop (50-80% of pts.)ECG atrial fibrillation may develop (50-80% of pts.)

Echocardiogram (2D Echo) Echocardiogram (2D Echo) most sensitivemost sensitive in diagnosisin diagnosis


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INTERVENTIONSINTERVENTIONS

Na+ restriction, diuretics to relieve pulmonary congestionNa+ restriction, diuretics to relieve pulmonary congestion

bed rest, sitting positionbed rest, sitting position Digitalis improve cardiac contraction,Digitalis improve cardiac contraction, HR, treat atrialHR, treat atrial

fibrillationfibrillation

Anticoagulants (blood thinners) aspirin, PlavixAnticoagulants (blood thinners) aspirin, Plavix

Surgical interventions:Surgical interventions: Mitral commissurotomy separation or incision of theMitral commissurotomy separation or incision of the

stenosed valve leaflets at their borders or commissuresstenosed valve leaflets at their borders or commissures

Balloon mitral valvuloplastyBalloon mitral valvuloplasty

Mitral valve replacement when stenosis is severeMitral valve replacement when stenosis is severe


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BalloonBalloon

mitralmitral

valvuloplavalvulopla

stysty


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Mitral RegurgitationMitral Regurgitation

incomplete closure of the mitral valveincomplete closure of the mitral valve rheumatic disease is the predominant causerheumatic disease is the predominant cause may also be due to congenital anomaly, infectivemay also be due to congenital anomaly, infectiveendocarditis,endocarditis,

rupture of papillary muscle following MIrupture of papillary muscle following MI


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MitralMitral

RegurgitatioRegurgitationn


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Incomplete closure ofmitral valve

vol. of bloodejected by left

ventricle Left atrial pressure

Right-sided heart

failure

Left atrialhypertrophy

CO

Pulmonarypressure

Backflow of blood tothe left atrium

Right ventricularpressure


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CLINICALCLINICAL

MANIFESTATIONSMANIFESTATIONS

Fatigue & weaknessFatigue & weakness due to due to CO predominant complaintCO predominant complaint exertional dyspnea & cough pulmonary congestionexertional dyspnea & cough pulmonary congestion palpitations due to atrial fibrillation (occur in 75% of pts.)palpitations due to atrial fibrillation (occur in 75% of pts.) Right-sided heart failure distended neck veins, edema,Right-sided heart failure distended neck veins, edema,

ascites, hepatomegalyascites, hepatomegaly Auscultation: blowing, high-pitchedAuscultation: blowing, high-pitched systolic murmursystolic murmur (apex)(apex)


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restrict physical activity to prevent fatigue & dyspnearestrict physical activity to prevent fatigue & dyspnea Na+ intake, diuretics relieve congestionNa+ intake, diuretics relieve congestion Digitalis, vasodilators promote adequate ventricularDigitalis, vasodilators promote adequate ventricular

emptying and prevent or decrease regurgitationemptying and prevent or decrease regurgitation

ACE inhibitors arterial dilation,ACE inhibitors arterial dilation, afterloadafterload

Surgery:Surgery:- Valvuloplasty (repair or reconstruction)- Valvuloplasty (repair or reconstruction)

- Valve replacement- Valve replacement


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Mitral Valve Prolapse


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Mitral Valve ProlapseMitral Valve Prolapse when 1 or both of the valve leaflets bulge into the leftwhen 1 or both of the valve leaflets bulge into the left

atrium during ventricular contractionatrium during ventricular contraction more common in womenmore common in women CauseCause: due to an inherited connective tissue disorder: due to an inherited connective tissue disorder

enlargement of one or both valve leafletsenlargement of one or both valve leaflets

Elongates/stretches the chordae tendinae & papillaryElongates/stretches the chordae tendinae & papillary

musclesmuscles regurgitation may occurregurgitation may occur usually asymptomaticusually asymptomatic Extra heart soundExtra heart sound (Mitral click)(Mitral click)arrhythmiasarrhythmias may develop dizziness, chest pain, dyspnea,may develop dizziness, chest pain, dyspnea,

palpitations, syncopepalpitations, syncope


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Mitral Valve ProlapseMitral Valve Prolapse

Interventions:Interventions:

antibiotic prophylaxis to prevent endocarditisantibiotic prophylaxis to prevent endocarditis

If w/ dysrhythmia avoid caffeine, alcohol, stopIf w/ dysrhythmia avoid caffeine, alcohol, stopsmokingsmoking

anti-arrhythmic drugsanti-arrhythmic drugs for chest pain nitrates, calcium channelfor chest pain nitrates, calcium channel

blockers,blockers,beta blockersbeta blockers

surgery not indicatedsurgery not indicated


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Aortic StenosisAortic Stenosis

may be due to rheumatic heart disease,may be due to rheumatic heart disease,atherosclerosis,atherosclerosis,

congenital valvular disease or malformationscongenital valvular disease or malformations

narrowing of the aortic valvenarrowing of the aortic valve

flow of blood from the left ventricle to theflow of blood from the left ventricle to theaortaaorta

blood volume and pressure in the leftblood volume and pressure in the leftventricleventricle

Left ventricle hypertrophyLeft ventricle hypertrophy develops as adevelops as a

compensatory mechanism to continuecompensatory mechanism to continue

pumping bloodpumping blood

through the narrowed openingthrough the narrowed opening


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Aortic Stenosis


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Aortic

Stenosis


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Stiffening/Narrowing ofAortic Valve

Incomplete emptying

of left atrium

Left ventricular

hypertrophy

Pulmonarycongestion

Compression ofcoronary arteries

Right-sided heart

failure

CO

MyocardialO2 needs

Myocardial ischemia(chest pain)

O2 supply


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CLINICALCLINICAL

MANIFESTATIONSMANIFESTATIONS

fatigue &fatigue & exertional dyspneaexertional dyspnea 1 1stst symptoms due tosymptoms due to COCO

and pulmonary congestionand pulmonary congestion

chest pain (angina)chest pain (angina) most common symptommost common symptom

- occurs during exercise - occurs during exercise due to inability of the heart todue to inability of the heart to

increase coronary blood flow to cardiac muscleincrease coronary blood flow to cardiac muscle

exertional syncopeexertional syncope, vertigo, periods of confusion --, vertigo, periods of confusion -- COCO weakness, orthopnea, PND, pulmonary edema (severeweakness, orthopnea, PND, pulmonary edema (severecases)cases)

signs of right-sided heart failure - end-stage symptomssigns of right-sided heart failure - end-stage symptoms- if untreated, survival rate: 1.5-3 years- if untreated, survival rate: 1.5-3 years

Auscultation: mid-systolic murmurAuscultation: mid-systolic murmur


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restrict activityrestrict activity digitalisdigitalis Na+ restriction, diureticsNa+ restriction, diuretics

Nitroglycerin for chest painNitroglycerin for chest pain Surgical:Surgical: Balloon aortic valvuloplastyBalloon aortic valvuloplasty

Aortic valve replacement if not done - poorAortic valve replacement if not done - poorprognosisprognosis


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Aortic RegurgitationAortic Regurgitation

may be due tomay be due to

rheumatic fever rheumatic fever

most commonmost common

causecause

other causes:other causes:

connective tissueconnective tissue

disease (Marfansdisease (Marfans

syndrome),syndrome),

severesevere

hypertension,hypertension,

congenitalcongenital

anomalyanomaly


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AorticAortic

RegurgitationRegurgitation


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Incomplete closure ofthe aortic valve

Backflow of blood toLeft ventricle

Left ventricularhypertrophy &

dilation

Left atrial pressureLeft-sided heart

failure

(late stage)

Left atriumhypertrophy

CO Pulmonary

pressure

Right-sided heart

failure

Rightventricular

pressure


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CLINICAL MANIFESTATIONSCLINICAL MANIFESTATIONS

pt. may remain asymptomatic for years --- heartpt. may remain asymptomatic for years --- heart

compensates by hypertrophy & dilationcompensates by hypertrophy & dilation

bounding pulsebounding pulse,, marked carotid artery pulsationmarked carotid artery pulsation,, apicalapicalpulsepulse force and volume of contraction of theforce and volume of contraction of the

hypertrophied left ventriclehypertrophied left ventricle

Decompensation occurs (cardiac muscle fatigue)Decompensation occurs (cardiac muscle fatigue)

exertional dyspneaexertional dyspnea

chest pain myocardial ischemiachest pain myocardial ischemia left-heart failure fatigue, orthopnea, PNDleft-heart failure fatigue, orthopnea, PND right-heart failure peripheral edemaright-heart failure peripheral edema

AuscultationAuscultation: soft, blowing diastolic murmur: soft, blowing diastolic murmur


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MANAGEMENTMANAGEMENT

antibiotic prophylaxis before any invasive orantibiotic prophylaxis before any invasive or

dentaldental

proceduresprocedures

avoid physical exertion, competitive sportsavoid physical exertion, competitive sports

vasodilators, calcium channel blockers, ACEvasodilators, calcium channel blockers, ACE

inhibitorsinhibitors

Aortic valvuloplasty or valve replacementAortic valvuloplasty or valve replacement


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Tricuspid StenosisTricuspid Stenosis

usually occurs together w/ aortic or mitral stenosisusually occurs together w/ aortic or mitral stenosis may be due to rheumatic heart diseasemay be due to rheumatic heart disease blood flow from right atrium to right ventricleblood flow from right atrium to right ventricle

right ventricular outputright ventricular output left ventricular fillingleft ventricular filling

COCO

blood accumulates in systemic circulationblood accumulates in systemic circulation systemic pressuresystemic pressure

S/Sx: symptoms of right-sided heart failureS/Sx: symptoms of right-sided heart failure

- hepatomegaly- hepatomegaly

- peripheral edema- peripheral edema

- neck vein engorgement- neck vein engorgement

-- CO fatigue, hypotensionCO fatigue, hypotension


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Tricuspid RegurgitationTricuspid Regurgitation

uncommon, may be caused by RF, bacterialuncommon, may be caused by RF, bacterialendocarditisendocarditis

may also be caused by enlargement of rightmay also be caused by enlargement of rightventricleventricle

an insufficient tricuspid valve allows blood to flowan insufficient tricuspid valve allows blood to flow

backbackinto the right atriuminto the right atrium venous congestion &venous congestion &

rightright

ventricular outputventricular output blood flow towards theblood flow towards the

lungslungs


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CLINICALCLINICAL

MANIFESTATIONSMANIFESTATIONS may not produce any symptomsmay not produce any symptoms moderate-to-severe tricuspid regurgitation exist, the ff.moderate-to-severe tricuspid regurgitation exist, the ff.

may result:may result:

Active pulsing in the neck veinsActive pulsing in the neck veins Swelling of the abdomenSwelling of the abdomen Swelling of the feet and anklesSwelling of the feet and ankles Fatigue, tirednessFatigue, tiredness WeaknessWeakness Decreased urine outputDecreased urine output

on palpation, there may be aon palpation, there may be a liftlift (beating of enlarged right(beating of enlarged right

ventricle)ventricle)

murmur on auscultationmurmur on auscultation


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Pulmonic Valve StenosisPulmonic Valve Stenosis

rare, usually congenital in originrare, usually congenital in origin flow of blood to the pulmonary artery due toflow of blood to the pulmonary artery due tonarrowingnarrowing

blood flows back to right ventricle and right atriumblood flows back to right ventricle and right atrium

right ventricle hypertrophy to compensate forright ventricle hypertrophy to compensate for

blood volume and force blood to the pulmonaryblood volume and force blood to the pulmonaryarteryartery

S/Sx:S/Sx: harsh systolic murmurharsh systolic murmur fatigue, dyspnea on exertion, cyanosisfatigue, dyspnea on exertion, cyanosis

poor weight gain or failure to thrive in infantspoor weight gain or failure to thrive in infants he atome al ascites edemahe atome al , ascites, edema


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Pulmonary RegurgitationPulmonary Regurgitation

a rare condition caused by infective endocarditis,a rare condition caused by infective endocarditis,

tumors or RFtumors or RF

blood flows back into Right ventricleblood flows back into Right ventricle RightRightventricleventricle

and atrium hypertrphyand atrium hypertrphy symptoms of Right-sidedsymptoms of Right-sided

heart failureheart failure


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Valve RepairValve Repair

ValvuloplastyValvuloplasty is repair of cardiac valveis repair of cardiac valve

pt. does not require continuous anti-coagulantpt. does not require continuous anti-coagulantmedicationmedication

usually require cardiopulmonary bypass machineusually require cardiopulmonary bypass machine

1.1.CommissurotomyCommissurotomy to separate the fused leaflets to separate the fused leaflets

Balloon ValvuloplastyBalloon Valvuloplasty performed in the cardiac performed in the cardiaccath. lab.cath. lab.- balloon inflated for 10-30 secs., w/ multiple- balloon inflated for 10-30 secs., w/ multiple

inflations.inflations.

- common used for mitral and aortic stenosis.- common used for mitral and aortic stenosis.

Closed surgical valvuloplastyClosed surgical valvuloplasty

done in the OR under done in the OR under

GAGA

- midsternal incision, a small hole is cut into- midsternal incision, a small hole is cut intothe heart,the heart,

the surgeons finger or a dilator is used to open thethe surgeons finger or a dilator is used to open the

commissurecommissure

Open CommissurotomyOpen Commissurotomy done w/ direct visualization done w/ direct visualization


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Valve Repair (cont.)Valve Repair (cont.)

2. Annuloplasty2. Annuloplasty is repair of valve annulus (junction of the valveis repair of valve annulus (junction of the valveleafletsleaflets

and the muscular heart wall)and the muscular heart wall)

- narrows the diameter of the valves orifice, useful for- narrows the diameter of the valves orifice, useful for

valvular regurgitationvalvular regurgitation

3. Chordoplasty3. Chordoplasty is repair of chordae tendineaeis repair of chordae tendineae

- done for mitral valve regurgitation caused by- done for mitral valve regurgitation caused by

stretched,stretched,

torn or shortened chordae tendineaetorn or shortened chordae tendineae


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AnnuloplastyAnnuloplasty


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Annuloplasty (cont.)Annuloplasty (cont.)


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Valve ReplacementValve Replacement

Mechanical valves Ex. Caged ball valve, Tilting-disk valveMechanical valves Ex. Caged ball valve, Tilting-disk valve

- more durable, used for younger pts.- more durable, used for younger pts.

- risk of thromboembolism long-term use of anti-- risk of thromboembolism long-term use of anti-

coagulantscoagulants

Tissue or biological valves:Tissue or biological valves:

- xenografts - xenografts porcine or bovine heterograftsporcine or bovine heterografts (7-10 yrs(7-10 yrs

viability)viability)

- homografts from cadaver tissue donations (10-15- homografts from cadaver tissue donations (10-15

yrs)yrs)

- autografts excising the pts.s own pulmonic valve- autografts excising the pts.s own pulmonic valveandand

portion of pulmonary artery for use as the articportion of pulmonary artery for use as the artic

valvevalve

Antibiotic prophylaxisAntibiotic prophylaxis


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Valve ProsthesisValve Prosthesis


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Cardiopulmonary BypassCardiopulmonary Bypass

MachineMachine


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Cardiomyopathies &Cardiomyopathies &

ValvularValvular DisordersDisorders

C di thiC di thi


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CardiomyopathiesCardiomyopathies

Disease of the Heart MuscleDisease of the Heart Muscle

FACTS:FACTS:Cardiomyopathy is the 2Cardiomyopathy is the 2ndnd mostmostcommon cause of sudden deathcommon cause of sudden death

** CAD is #1**** CAD is #1**

Prognosis for DilatedPrognosis for DilatedCardiomyopathy is very poorCardiomyopathy is very poor

** Undiagnosed until in advanced stages **** Undiagnosed until in advanced stages **

C di thiC di thi


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RISK FACTORS:RISK FACTORS:

HypertensionHypertension

PregnancyPregnancy

Viral InfectionsViral Infections

ETOH AbuseETOH AbuseMales (overall)Males (overall)

African descent (both sexes)African descent (both sexes)


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C di thiCardiom opathies


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DILATED CARDIOMYOPATHYDILATED CARDIOMYOPATHYPrimarilyPrimarilyaffects systolicaffects systolic

functionfunction

Results fromResults from

extensiveextensive

damage todamage tomyocardialmyocardial

muscle fibersmuscle fibers

End-resultEnd-result

DILATEDDILATED


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Poor CompensationPoor Compensation

SV, EF, and COSV, EF, and CO

PulmonaryPulmonaryCongestionCongestion

If end-diastolic volumesIf end-diastolic volumes

increaseincrease **

DILATEDDILATED

CARDIOMYOPATHYCARDIOMYOPATHY

DILATEDDILATED


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Sympathetic Nervous System isSympathetic Nervous System isstimulatedstimulated

** Increases HR & Contractility **** Increases HR & Contractility **

Kidneys are stimulated (Kidneys are stimulated (Renin-Renin-AngiotensinAngiotensin) to Retain Na & H) to Retain Na & H

22OO

** Maintain adequate CO **** Maintain adequate CO **

VasoconstrictionVasoconstriction also Occursalso Occurs

DILATEDDILATED


DILATEDDILATED


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When compensatory triggers can noWhen compensatory triggers can no

longer keep up to maintainlonger keep up to maintain

adequate COadequate CO

The Heart Begins to Fail!!!The Heart Begins to Fail!!!

DILATEDDILATED


Idiopathic DilatedI opat c D ate


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Idiopathic DilatedI opat c D ateCardiomyopathyCardiomyopathy

common cause of heart failurecommon cause of heart failure

Incidence increases with age and isIncidence increases with age and ishigher in maleshigher in males

50% of IDC cases may be familial50% of IDC cases may be familial

Endomyocardial biopsy provides aEndomyocardial biopsy provides adefinitive diagnosisdefinitive diagnosis

Moser & Riegel, 2008, p. 1110Moser & Riegel, 2008, p. 1110

Secondary DilatedSecon ary D ate


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Secondary DilatedSecon ary D ateCardiomyopathyCardiomyopathy

Ischemic Dilated CardiomyopathyIschemic Dilated CardiomyopathyThe most common typeThe most common type

About 15% to 45% of patients whoAbout 15% to 45% of patients whohave ahave a myocardial infarctionmyocardial infarction willwilldevelop dilatation of the leftdevelop dilatation of the leftventricle with a decrease inventricle with a decrease in

ejection fractionejection fraction

Prognosis isPrognosis is worseworse for ischemicfor ischemiccardiomyopathy, than for non-cardiomyopathy, than for non-

ischemic cardiomyopathiesischemic cardiomyopathies

Secondary DilatedSecon ary D ate


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Secondary DilatedSecon ary D ateCardiomyopathyCardiomyopathy

HypertensiveHypertensive DilatedDilatedCardiomyopathyCardiomyopathy

ValvularValvular Dilated CardiomyopathyDilated Cardiomyopathy

AnthracyclineAnthracycline DilatedDilatedCardiomyopathyCardiomyopathy

(Anthracycline = Anticancer Agent)(Anthracycline = Anticancer Agent)

PeripartumPeripartum Dilated CardiomyopathyDilated Cardiomyopathy

Alcohol-RelatedAlcohol-Related DilatedDilated

Signs &Signs &


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Dilated CardiomyopathyDilated Cardiomyopathy

May be overlooked until LV FailureMay be overlooked until LV FailureOccursOccurs

orthopneaorthopnea

Paroxysmal nocturnal dyspnea,Paroxysmal nocturnal dyspnea, Dry Cough @ night, FatigueDry Cough @ night, Fatigue

Peripheral Edema, Hepatomegaly,Peripheral Edema, Hepatomegaly,VD Wei ht Gain

Signs &Signs &

SymptomsSymptoms

Signs &Signs &


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Peripheral CyanosisPeripheral Cyanosis

TachycardiaTachycardia systolic Murmur (mitral/tricuspidsystolic Murmur (mitral/tricuspid

insufficiency)insufficiency)

SS33& S& S

44gallops rhythmsgallops rhythms

Irregular Pulse (with A-Fib)Irregular Pulse (with A-Fib)

Signs &Signs &

SymptomsSymptoms

TREATMENTTREATMENT


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TREATMENTTREATMENT


Management of underlying cause, ifManagement of underlying cause, if

knownknown ACEI (First-line), to reduceACEI (First-line), to reduce

afterloadafterload

DiureticsDiuretics DigoxinDigoxin

AntiarrhythmicsAntiarrhythmics

TREATMENT:TREATMENT:


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Pacemaker InsertionPacemaker Insertion

AnticoagulantsAnticoagulants Revascularization (CABG) if d/tRevascularization (CABG) if d/t

ischemiaischemia

Valvular Repair/ReplacementValvular Repair/Replacement Lifestyle ModificationsLifestyle Modifications

Heart TransplantHeart Transplant



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CardiomyopathiesCardiomyopathiesHYPERTROPHICHYPERTROPHIC

CARDIOMYOPATHYCARDIOMYOPATHYPrimarily AffectsPrimarily AffectsDiastolic FunctionDiastolic Function

(**(**fillingfilling***)***)

Features of HCM:Features of HCM: Asymmetrical LVAsymmetrical LVHypertrophyHypertrophy

Hypertrophy ofHypertrophy ofIntraventricular SeptumIntraventricular Septum(HOCM) : Obstruction of(HOCM) : Obstruction ofLV outflowLV outflow

HYPERTROPHICHYPERTROPHIC


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Hypertrophied ventriclesHypertrophied ventriclesbecomebecome stiffstiff ::

Do not relax duringDo not relax during

ventricular fillingventricular filling** aka Diastole **** aka Diastole **

Ventricular fillingVentricular filling

LV pressureLV pressure

Left Atrial &Left Atrial &Pulmonary VenousPulmonary Venous

PressuresPressures

HYPERTROPHICCARDIOMYOPATHYCARDIOMYOPATHY

HYPERTROPHICHYPERTROPHIC


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O CCARDIOMYOPATHYCARDIOMYOPATHY

STATISTICS:STATISTICS:

As many asAs many as 60% to 80%60% to 80% of cases areof cases are

inherited throughinherited through autosomalautosomaldominant transmissiondominant transmission

Usually goes undetected untilUsually goes undetected untiladulthoodadulthood

Signs &Signs &


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Hypertrophic CardiomyopathyHypertrophic Cardiomyopathy AnginaAngina DyspneaDyspnea FatigueFatigue

Systolic murmurSystolic murmur

Abrupt arterial PulseAbrupt arterial Pulse

Irregular Pulse (with A-fib)Irregular Pulse (with A-fib)

Signs &Signs &SymptomsSymptoms



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HypertrophicHypertrophic

CardiomyopathyCardiomyopathy

Beta-BlockersBeta-Blockers(( HR, O HR, O

22demand,demand,

improve ventricularimprove ventricular

filling)filling)

CardioversionCardioversion (A-Fib to(A-Fib to

Sinus)Sinus)

AnticoagulantsAnticoagulants




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RESTRICTIVE CARDIOMYOPATHYRESTRICTIVE CARDIOMYOPATHYCharacterized asCharacterized asstiffness of thestiffness of the

ventricleventricle** LV Hypertrophy & Endocardial** LV Hypertrophy & Endocardial

Fibrosis Thickening **Fibrosis Thickening **

Ventricle does notVentricle does notrelax during diastolerelax during diastole** Ventricular Filling Reduced **** Ventricular Filling Reduced **

The rigidity of theThe rigidity of the

myocardium causesmyocardium causesfailure to completelyfailure to completely

contract duringcontract during

Signs &Signs &


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Restrictive CardiomyopathyRestrictive Cardiomyopathy Chest PainChest Pain DyspneaDyspnea FatigueFatigue

OrthopneaOrthopnea EdemaEdema

Systolic murmursSystolic murmurs PallorPallor

SS

33 & S& S

44 gallops rhythmsgallops rhythms

Signs &Signs &SymptomsSymptoms



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RestrictiveRestrictive

CardiomyopathyCardiomyopathy

Management ofManagement of

underlying causeunderlying cause

DigoxinDigoxin

DiureticsDiuretics

Restricted Na DietRestricted Na Diet


Lecture Cardio Physiotherapy 2

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