0071643192.pdf

CARDIOVASCULAR EMERGENCIES

ACE inhibitors play an

important role in the

treatment of myocarditis.

■ CXR: Usually normal, but may show cardiomegaly or pulmonary edema

■ ECG: Dilated chambers and diffuse or focal hypokinesis

■ CBC: Mild elevation of WBC count

■ Elevated ESR

■ Elevated cardiac enzymes

■ Biopsy: May be helpful but can miss areas of involvement (false-negative)

TREATMENT

■ Address infectious etiology, if identified.

■ Supportive care

■ Bed rest

■ IVIG and ASA for Kawasaki’s in children

■ Diuresis for CHF

■ ACE inhibitorshelp reduce myocardial inflammation.

COMPLICATIONS

■ Sudden death

■ Emboli

■ Dysrhythmias

■ Dilated cardiomyopathy

A 32-year-old female presents to the ED with 2 days of progressive short-

ness of breath. She is 3 weeks postpartum after an uneventful pregnancy

and vaginal delivery. On examination, the patient is in mild respiratory dis-

tress, has bilateral rales, jugular venous distention, and is tachycardic to a rate of

120 bpm. Bedside echocardiogram shows dilated chambers and poor systolic

function. What is the treatment of choice for this patient?

The patient likely has a peripartum dilated cardiomyopathy. ACE inhibitors

are essential in the treatment of dilated cardiomyopathies. If they are not toler-

ated (or if the patient were still pregnant) a combination of hydralazine and ni-

trates should be started.

CARDIOMYOPATHIES

Cardiomyopathies encompass a group of pathologies that alter the structure of

the heart itself, impairing normal cardiac function. Based on the World

Health Organization classification, there are four types of cardiomyopathy:

■ Dilated

■ Hypertrophic

■ Restrictive

■ Arrhythmogenic right ventricular dysplasia

Extrinsic causes of cardiomyopathy include hypertension, valvular disease,

ischemia, systemic disease, and inflammation.

Dilated Cardiomyopathy

Dilated cardiomyopathy is a spectrum of disorders resulting in depressed myo-

cardial systolic function and pump failure. All four chambers are dilated.

Four types of cardiomyopathy:

Dilated

Hypertrophic

Restrictive

Arrhythmogenic right

ventricular dysplasia