• Cardiomyopathy
    • The major pathological features are related to ventricular dysfunction
      • Systolic dysfunction
        • This is the predominant form of dysfunction in DCM. There is a reduced EF.
        • Initial compensation occurs with enlargement of the LV cavity, but eventually these fail.
      • Diastolic dysfunction
        Link:Diastolic dysfunction
        • Major feature of restrictive and hypertrophic CM. It is characterised by impaired LV filling with increased LV filling pressures. Usually the LV undergoes active relaxation during early diastole, and in late diastole fills passively.
        • Diastolic dysfunction can be due to impairment of active relaxation (usually due to ischaemia) or a reduction in compliance (fibrosis, pericardial disease) or both.
    • Dilated cardiomyopathy
      • Progressive cardiac dilatation
      • Unknown aetiology often, can be familial, viral, ischaemic, valvular, alcohol, SCD, muscular dystrophy, post-partum (may recur in subsequent pregnancies)
      • Signs
        • Tachycardia, dyspnoea, ascites, peripheral oedema, murmurs due to annular dilatation, thrombus
      • Treatments
        • As for CCF
          • β-blockers, ACE(I), spironolactone, ATIIRA, diuretics, biventricular pacing, anticoagulants
      • Management
        • Cardiology advice
        • Echo
        • Consider regional as it may improve c.o.
        • Avoid hypotension though
        • Avoid tachycardia
        • Prevent increased afterload
        • Maintain adequate preload
        • Dopamine, dobutamine, PDE inhibitors, Levosimendan. Caution with NA.
    • Restrictive CM
      • Due to idiopathic, haemochromatosis, amyloidosis, sarcoidosis
      • Main feature is diastolic dysfunction with reduction in ventricular compliance
      • Medical Rx aims to lower elevated filling pressures without reducing c.o. with ACE(I) and β-blockers.
      • Anaesthetic Mx aims to maximise RV preload. Aim to keep SVR high (avoid LA)
      • AF, 3rd HS are seen
    • HCM
      • Autosomal dominant
      • Unexplained LVH (concentric or asymmetrical, diffuse or local)
      • Syncope, SOB, chest pain, arrhythmias, hypotension, ESM, MR murmur may all be heard.
      • Diastolic dysfunction is common so there is an increase in the contribution form the atria which is why AF is poorly tolerated
      • Increased LVEDP leads to decreased CPP
      • Rx with β-blockers +/- verapamil, ICD, myomectomy, septal ablation techniques
      • LVOT obstruction can occur if the LV is under filled due to the velocity of blood in the outflow tract drawing in the anterior mitral valve leaflet
      • Rx
        • Maintain sinus
        • Reduce sympathetic activation
        • Maintain LV filling
        • Maintain SVR
        • Treat HT with β-blocker
        • Try to avoid regional
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/9/6/189.full.pdf