Cardiomyopathies

 

 

Considerations

 

  • ↑ risk of perioperative hemodynamic compromise:

    • CHF, dysrhythmias, emboli, myocardial ischemia

  • Type, etiology & severity of cardiomyopathy:

    • Dilated, restrictive, hypertrophic, peripartum

    • Presence of CHF including EF, NYHA class

    • Assess volume status & sympathetic activation

  • Hemodynamic goals specific to type of cardiomyopathy:

    • Restrictive (diastolic failure): 

      • Goals: fast, full & tight (as per tamponade)

        • Contractility: maintain

        • Rate & rhythm: sinus (atrial kick important), avoid bradycardia (SV relatively fixed)

        • Afterload: maintain (coronary perfusion with ↑ LVEDP)

        • Preload: maintain normovolemia (but avoid ↑ LVEDP)

    • Dilated (systolic failure):

      • Contractility: Maintain

      • Rate & rhythm: NSR

      • Afterload: maintain, may benefit from ↓

      • Preload: normal HR, avoid ↑ afterload

    • HOCM:

      • Contractility: ↓

      • Rate & rhythm: strict NSR, avoid tachycardia

      • Afterload: maintain

      • Preload: full

  • AICD/pacemaker considerations if applicable

  • Comorbid disease including possible systemic implications of etiology (eg. infiltrative disease)

  • Medication management: beta blockers, ACEI, anticoagulation, diuretics

 

 

 

Etiologies

 

  • Dilated cardiomyopathy:

    • Idiopathic (50%)

    • Ischemic (7%)

    • Valvular

    • Viral

    • Alcoholic

    • Toxic (eg. cocaine, chemo, radiation)

    • Familial 

    • Peripartum

    • Other: SLE, ESRD, hyperthyroidism, Duchenne's

  • Hypertrophic cardiomyopathy:

    • HOCM

    • Hypertensive cardiomyopathy

    • Valve lesion (e.g. AS)

  • Restrictive cardiomyopathy:

    • Amyloidosis

    • Hemochromatosis

    • Sarcoidosis

    • Scleroderma

    • Radiation-induced

    • Idiopathic