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1、HeartMuscleDisease: CardiomyopathyLauraWexler,M.D.558-5575wexlerl@ucmail.uc.eduCaseA56yearoldmancomestoyourofficecomplainingofthreemonthsofprogressivefatigueanddyspneaonexertion.Severaltimesinthepastmonthhehasawakenedfromsleepwithseverebreathlessnessandfeltaneedtosit
2、upinordertobreath.Hedeniesanychestpainorpressure.Healsohasnoticedsomeankleswelling.Hehasnopastmedicalhistoryofheartdisease,hypertensionordiabetes.Hisfamilyhistoryisnegativeforheartdisease.Hedoesnotsmokeanddrinksalcoholonlyrarely.Hetakesnomedications.PhysicalExamBP105
3、/70,P98regular,T98.6?,RR20Carotidsarelowvolumewithnormalupstroke.JVPelevated:10cmabovethesternalangle.Lungs:Bibasilarrales.Heart:PMIdiffuse,palpableattheanterioraxillaryline.S1diminishedintensity,S2normal,S3ispresent.2/6holosystolicmurmurattheapex.Abdomen:Liverisenla
4、rged(span11cm)andslightlytendertopressure.Positivehepatojugularreflex(+HJR).Noascites.Extremities:Mildedemaofbothfeetandankles.DilatedCardiomyopathyDilationofoneorbothventriclesGloballyimpairedventricularsystolicfunction:bothventriclesorpredominantlytheleftventricle.
5、IsolatedRVcardiomyopathyisrare.CardiomyopathiesDiagnosticstudiesECG:NSRat82bpm.NospecificfindingsImagingChestX-Ray:cardiomegalyandpulmonarycongestion.Echocardiogram:Biventricularenlargementandglobalhypokinesis.Radionuclideventriculogram(MUGA):RVEF30%,LVEF20%,globalhy
6、pokinesis.Cardiaccath:contrastleftventriculogram.*DilatedCardiomopathy:MUGASystolicheartfailureEtiologyofdilatedcardiomyopathyCoronaryarterydiseaseIdiopathicHypertensiveheartdiseaseFamilial/geneticViral/otherinfectiousagents(HIV)Immune/autoimmuneAlcoholic/toxic(cocai
7、ne,chemotherapeuticdrugs)Infiltrative(hemochromatosis,sarcoidosis,amyloidosis)PostpartumNaturalHistoryofDilatedCardiomyopathyCongestiveheartfailureArrhythmias(Afib,VT)SuddendeathThromboembolismChestpainDiagnosisofDilatedCardiomyopathyExcludeothercausesofcontractilefa
8、ilure(HTN,CAD,valvulardisease).Testforspecificetiologies?PercutaneousendomyocardialbiopsyGoalsofTherapyinDilatedCardiomyopathyAllev
