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Peripartum Cardiomyopathy (Potential theories (Familial - genetic or…
Peripartum Cardiomyopathy
Heart tissue dilates
Decreased contractility
Decreased LVEF <45%
Decreased cardiac output (Q) and impaired venous return
sympathetic innervation
Increased MAP (after load)
Increased pooling in left ventricle/Increased preload
Increased sympathetic innervation
Sympathetic symptoms
4 more items...
Medical Management
Increase inotropic effect
Digitalis
Inhibition of sodium-potassium ATP
Allows calcium to accumulate in myocytes
Increase in cardiac contractility
Inhibition of arrhythmias
Dopamine (B1 sympathetic agonist)
Increase HR (chronotropic effect)
Increase in myocardial contractility (inotropic effect)
Decrease cardiac workload
Beta blockers
negative chronotrope
Decrease heart rate
Decrease myocardial oxygen demands
Negative inotrope
Decrease in myocardial contractility
Decrease in myocardial workload
i.e. Atenolol, Metroprolol, Propranolol
ACE inhibitors
Inhibits NA+ and water retention
Reduction in plasma volume
Reduction in BP
Reduction in myocardial workload
Prevents vasoconstriction from Angiotensin II
i.e. Captopril, Enalapril, Fosinopril
Diuretics
Facilitates formation/excretion of urine
Reduce plasma volume
Reduce cardiac output
i.e. Thiazides, Loop Diuretics, Potassium Sparing Agents
Vasodilators
Reduction in peripheral BP
Decrease of afterload and preload
i.e. Nitrates, ARBs, CCBs
LVAD
mechanical support device
attched to left ventricle and aorta
receives blood leaving left ventricle and assists transportation to aorta
decreasing work of the heart
HR assessed via doppler
MAP maintained b/t 60-80mmHg
Pulse assesed via telemetry monitor
Uses of LVAD
Bridge To Transplat
Improve Patient Strength and Endurance, and Increase Particpation
Destination Therapy
benefits
Blood Pressure Support
improve/maintain blood flow to organs
improving/maintaining organ function
Potential theories
Familial - genetic or environmental factors
Myocarditis: Increased susceptibility to viral or autoimmune disorders
Abnormal Immune Response: if fetal cells enter maternal circulation, a weak immune response from the mother can allow these cells to enter the cardiac tissue and trigger an immune response
Increased stress on circulatory system leads to hypertrophy of left ventricle, decreased contraction of heart and risk of heart failure
Iron build up of heart muscle (hemochromatosis)
Increased oxidative stress causes the separation of prolactin
Increased risk factors: long term high BP, metabolic disorders, pregnancy complications, alcohol/drug abuse, chemotherapy/radiation, infections affecting the heart, sarcoidosis
Frank Starling Mechanism
Heart Failure