Internal Medicine

0521779407-16 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

1112 Osteoporosis Other Cardiomyopathies

complications and prognosis

■Multiple compression fractures severely restrict functional activ-

ity, promote loss of esteem, depression, increased hospitalization,

increased mortality rate

■Treatment of fractures considerably less satisfactory than prevention

OTHER CARDIOMYOPATHIES

JOHN R. TEERLINK, MD

history & physical

Also see congestive heart failure, acute heart failure, and myocarditides

■Three main types of cardiomyopathies: Dilated, Hypertrophic, Res-

trictive.

History

■Family history of cardiomyopathy and/or sudden death

■Dilated cardiomyopathy may result form alcohol or other toxic expo-

sure

Signs & Symptoms

■Dilated: usually present with gradual onset of CHF symptoms, occa-

sionally symptomatic ventricular arrhythmias

■Hypertrophic: most frequently present with chest pain and dyspnea,

although postexertional syncope is more suggestive

■Restrictive: usually present with gradual onset of CHF symptoms,

occasionally symptomatic ventricular arrhythmias, or conduction

disturbances, depending on etiology

➣Dilated: consistent with CHF

➣Hypertrophic: bisferiens carotid upstroke, loud S4, triple apical

impulse, systolic murmur that augments with Valsalva or upright

posture and decreases with squatting

➣Restrictive: elevated JVP, Kussmaul’s sign, edema, consistent with

CHF with diastolic dysfunction

tests

■Basic Tests

➣As per CHF

■Specific Diagnostic Tests

➣Electrocardiogram: ST-T wave changes, conduction abnormali-

ties (all); septal Q waves, LVH (hypertrophic); low voltage (restric-

tive)