Resident Report 2/8 – Ischemic Cardiomyopathy

Teaching Pearls:

    • Ischemic cardiomyopathy is most common cause for development of LV thrombus.
    • Cardiogenic shock
      • MAP = CO x SVR
        • MAP decreased due to CO decrease. SVR increases to compensate.
      • Most commonly caused by ischemic cardiomyopathy
      • Presence of transaminitis, AKI, elevated lactic acid suggestive of hypoperfusion (cardiogenic shock)
    • Murmurs
      • Left sided heart disease
        • Murmurs decrease with inspiration
      • Right sided heart disease
        • Murmurs increase with inspiration
      • Squatting Test
        • Increases preload back to the heart
        • Causes increased intensity in all murmurs except HOCM and MVP
      • Valvsalva
        • Decreases preload back to the heart
        • Causes decreased intensity in all murmurs except HOCM and MVP
      • Fixed split S2
        • Due to ASD
        • Inspiration causes increased preload, leading to delayed P2 sound (causing the split)
        • Expiration causes increased blood return to left side of heart, which flows through ASD to right side of heart, also causing delayed P2 sound (causing the split).
        • Inspiratory and expiratory causes same effect towards P2, leading to fixed split S2.

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