Cardiomyopathy and Cardiac Valves

Cardiac Valves

• Aortic valve location: Second intercostal space (ICS) right of the sternum
• Pulmonic valve location: Second ICS left of the sternum
• Tricuspid valve location: Fourth ICS left of the sternum
• Mitral valve location: Fifth ICS left mid-clavicular line
• Erbs point is situated at the third ICS left of the sternum, here aortic and pulmonic regurgitation are heard

Cardiomyopathy: Dilated

• Dilated cardiomyopathy is characterized by a decrease in oxygen levels (↓O₂)
• Symptoms include restlessness, agitation, shortness of breath, fatigue, angina, and heart block
• It's caused by heart failure, where the heart doesn't pump blood forward effectively.
• Dilated cardiomyopathy affects the left ventricle, resulting in lung-related signs like crackles and pulmonary edema.
• It also affects the right ventricle, leading to edema, ascites, and jugular venous distention (JVD)
• Tricuspid and bicuspid regurgitation can occur, leading to a narrow pulse pressure due to a reduced ejection fraction.

Cardiomyopathy: Restrictive

• Restrictive cardiomyopathy involves stiff heart muscles that don't stretch properly, leading to problems with heart filling.
• Scar tissue formation also hinders proper blood flow and filling.
• Reduced blood inflow results in reduced blood outflow
• Symptoms include decreased oxygen levels, fatigue, and shortness of breath.

Heart Failure

• Heart failure can be caused by Amyloidosis, a build-up of abnormal proteins
• Sarcoidosis, a disorder characterized by inflamed cell deposits, can also lead to heart failure.
• Hemochromatosis, an iron overload disorder, can contribute to heart failure.
• Radiation therapy to the heart can also cause heart failure

Genetic hypertrophic cardiomyopathy

• Genetic hypertrophic cardiomyopathy is caused by genetic mutations
• Thickened heart muscle walls, particularly the septum, are characteristic of this condition.
• Reduced blood inflow and outflow occur as a result of the thickened septum.
• The thickened septum can obstruct the aortic valve.
• Strain during exercise can worsen symptoms.
• Individuals are often asymptomatic until they experience sudden strain on the heart.
• Decreased oxygen levels lead to symptoms like shortness of breath, fatigue, weakness, syncope, altered level of consciousness, and chest pain.

Diagnosis and Treatment

• Diagnosis involves detecting a heart murmur and utilizing an electrocardiogram (ECG)
• Treatment involves beta-blockers, calcium channel blockers (CCB, like Verapamil), digoxin, antiarrhythmic drugs, diuretics, and vasodilators.
• These medications are aimed at treating the underlying cause of the conditions.
• First-line treatment includes beta-blockers, CCB, digoxin, anti-dysrhythmic drugs, diuretics, and vasodilators.
• Potential treatments include heart transplantation, surgical myectomy (widening the septum), and alcohol ablation (remodeling the septum).

Precautions

• Patients with these conditions should avoid activities that put strain on the heart, like lifting heavy weights, straining during bowel movements, and sudden changes in positions.