Introduction
Dilated cardiomyopathy (DCM) is “a syndrome characterized by cardiac enlargement and impaired systolic function of one or both ventricles.”4(1175) Through medical technology and proper medical regimen, people afflicted with this syndrome today, are living longer and are undergoing surgeries that may not be cardiac-related. Therefore, anesthesia providers may encounter increasing amounts of patients with DCM as compared in the past. As anesthesia providers, it is important to have an understanding of the pathophysiology of DCM and its anesthetic implication. This topic will focus on anatomy and physiology of DCM, the effects it has on the anesthetic plan, and a review of current literature.
Anatomy and Physiology
Patients with dilated cardiomyopathy will often have normal thickness of the ventricles with an enlarged right, left, or both ventricular cavities. In the early stages of this disease, there is an initial increase in the stroke volume from the increased force of contraction due to the stretching of the myocardium, which is described by the Frank-Starling mechanism. However, as the disease progresses, the heart loses that compensatory mechanism leading to a decrease in the strength of the contraction of the heart, hence, a decrease in left ventricular ejection fraction. There are two types of DCM, primary and secondary. Primary dilated cardiomyopathy are usually idiopathic in nature, however, “approximately 30% of cases” have a “familial transmission pattern.”3(138) Secondary dilated cardiomyopathy, on the other hand, are associated with “alcohol abuse, cocaine abuse, the peripartum state, pheochromocytoma, infectious diseases (human immunodeficiency virus infection), uncontrolled tachycardia, Duchenne’s muscul...
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...ncrease work of the heart.
Conclusion
Anesthetic management for patients with dilated cardiomyopathy is challenging. It is imperative that there should be a complete preoperative assessment to tailor the anesthetic plan specifically for the patient. Ensure that the patient has an optimized cardiac status and does not have any symptoms of heart failure prior to elective surgeries because it increases morbidity and mortality. The anesthesia provider needs to be very vigilant throughout the perioperative period and prompt administration of inotropes or anti-arrhythmic medications may be required. Patients with dilated cardiomyopathy presents a challenge to anesthetic providers, thus, a good understanding of the disease, its affects, along with a thorough preoperative assessment, will be beneficial in formulating a customized anesthetic plan to prevent adverse outcomes.
Inadvertent perioperative hypothermia is a common anesthesia-related complication with reported prevalence ranging from 50% to 90%.(ref 3,4 of 4) The clinical consequences of perioperative hypothermia include tripling the risk of morbid myocardial outcomes and surgical wound infections, increased blood loss and transfusion requirements, and prolonged recovery and hospitalization.(ref 5)
Prior to intubation for a surgical procedure, the anesthesiologist administered a single dose of the neuromuscular blocking agent, succinylcholine, to a 23-year-old female to provide muscular relaxation during surgery and to facilitate the insertion of the endotracheal tube. Following this, the inhalation anesthetic was administered and the surgical procedure completed.
4. Right Ventricular hypertrophy (RVH) – In a normal heart, the left ventricle has a rather thicker wall than the right due to the fact that it has to pump oxygenated blood to the body as opposed to the right ventricle which only needs to pump deoxygenated blood to the lungs. However, Tetralogy of Fallot causes an enlargement of the right ventricular muscle due to the pulmonary stenosis in the pulmonary
This is induced by the sliding of the cardiac myofibril. Hypertrophic Cardiomyopathy, also known as HCM, is a type of heart disease that affects the Cardiac Muscles and Cardiac Muscle cells. This disease occurs if the Cardiac Muscle cells enlarge, which causes the wall of the heart’s ventricles (most often the left ventricle) to thicken. It can also cause stiffness in the ventricles, as well as mitral valve and cellular changes. On a cellular level, HCM can cause the cells to become disorganised and lost.
In a healthy individual receiving a general anaesthetic, the anaesthetist must be aware of the causes and treatment of acute onset AF, both intra-operatively and peri-operatively. Patients with AF often develop a decline in left ventricular performance and other hemodynamic instabilities including reduced diastolic filling and tachycardia mediated cardiomyopathy1, all of which can reduce cardiac output and pose difficulties for the anaesthetist.
Capture Myopathy? Not very often a diagnosis is termed liked this, especially in the field of human medicine, especially n the field of cardiology the where the term myopathy is revered as Cardiomyopathy. Myopathy is a disease that affects the muscles and causes weakness due to dysfunction of muscle fibers (1); Cardiomyopathy is of the same circumstance but deals primarily with the heart. Capture Myopathy is relative to many animals, especially mammals and provides a definitive correlation to humans and their potential medical prognosis of Cardiomyopathy. Capture Myopathy is a syndrome that that occurs within captive animals and causes rapid death through excessive adrenaline within the bloodstreams. (3) Capture Myopathy is quite often referred to as white muscle disease, the muscle when used causes a change of metabolism from using oxygen to using the stored energy within the muscle. The change up allows for lactic acid to build up and make its way into the bloodstream where it changes the homeostasis of the body: the body pH and the heart output. In essence, if the heart is inefficiently pumping the correct oxygen to the muscle, the muscle will begin to deteriorate and ultimately lead to damages to the kidney and the effector organs. (2) Animal Capture Myopathy is very relatable to human Takotsubo Cardiomyopathy, and thus this paper will aim to trace how animals are very relatable to humans even through the Cardiovascular System based on normal physiology and stress. (WHAT SHOULD I TALK ABOUT?)
The skeletal and ultimate cardiac muscle fibers are affected by DMD. The disease starts by affecting the lower port...
Tokgozoglu, L. S., Ashizawa, T., Pacifico, A., Armstrong, R. M., Epstein, H. F., Zoghbi, W. A. Cardiac involvement in a large kindred with myotonic dystrophy: quantitative assessment and relation to size of CTG repeat expansion. JAMA 274: 813-819, 1995.
Dilated cardiomyopathy may build up over several years and not cause significant problems. However, over time the enlarged heart gradually weakens. This is called heart failure. Heart failure has several causes and cardiomyopathy is one of them.
Approximately, 1 of every 500 people is affected with hypertrophic cardiomyopathy, it is important for patients to understand the dynamics of the disease as it could potentially be life threatening. In most cases, the patients quality of life is not affected, but a few will experience symptoms that cause significant discomfort or undetected complications that could lead to sudden cardiac death. With that in mind, it would be beneficial to recognize what it is, specific causes, the steps of diagnoses, and the options for treatment.
Volles, D. F. (2011, April 11). University of Virginia Health System Adult and Geriatric Sedation/Analgesia for Diagnostic and Therapeutic Procedures. Retrieved May 12, 2011, from University of Virgina Health System: University of Virginia Health System Adult and Geriatric Sedation/Analgesia for Diagnostic and Therapeutic Procedures
...., & Jr, L. H. (1992). Release of vasoactive substances during cardiopulmonary bypass. Annals of Thoracic Surgery. doi:10.1016/0003-4975(92)90113-I-6
The heart is a pump with four chambers made of their own special muscle called cardiac muscle. Its interwoven muscle fibers enable the heart to contract or squeeze together automatically (Colombo 7). It’s about the same size of a fist and weighs some where around two hundred fifty to three hundred fifty grams (Marieb 432). The size of the heart depends on a person’s height and size. The heart wall is enclosed in three layers: superficial epicardium, middle epicardium, and deep epicardium. It is then enclosed in a double-walled sac called the Pericardium. The terms Systole and Diastole refer respectively and literally to the contraction and relaxation periods of heart activity (Marieb 432). While the doctor is taking a patient’s blood pressure, he listens for the contractions and relaxations of the heart. He also listens for them to make sure that they are going in a single rhythm, to make sure that there are no arrhythmias or complications. The heart muscle does not depend on the nervous system. If the nervous s...
Oxygen was first admitted to the client with chest pain over 100 years ago (Metcalfe, 2011). Chest pain is a large bracket that can contain many different conditions, but for the purpose of this analysis it is focused manly upon a myocardial infarction. A myocardial infarction is mainly referred to as a heart attack, and occurs when one or more coronary arteries leading to the heart reduce or completely stop blood flow (Tuipulotu, 2013 ). Administering high concentrations of oxygen to patients with chest pain is now embedded in guidelines, protocols and care pathways, even with a lack of clear supporting evidence (Nicholson, 2004 ). High concentration of oxygen means that up to 60% is administered (Knott, 2012). More recent research has suggested that the use of oxygen in this scenario is unnecessary and can lead to unwanted side effects, especially in normoxic cardiac patients (Moradkham & Sinoway, 2010 ). The aim of this comparative analysis is to dismantle and understand both the benefits and risks of the commonly known practice of administration of oxygen to the client with chest pain. Through completing this analysis using recent and appropriate evidence a more improved practice can be given and understood.
Anesthesia is used in almost every single surgery. It is a numbing medicine that numbs the nerves and makes the body go unconscious. You can’t feel anything or move while under the sedative and are often delusional after being taken off of the anesthetic. Believe it or not, about roughly two hundred years ago doctors didn’t use anesthesia during surgery. It was rarely ever practiced. Patients could feel everything and were physically held down while being operated on. 2It wasn’t until 1846 that a dentist first used an anesthetic on a patient going into surgery and the practice spread and became popular (Anesthesia). To this day, advancements are still being made in anesthesiology. 7The more scientists learn about molecules and anesthetic side effects, the better ability to design agents that are more targeted, more effective and safer, with fewer side effects for the patients (Anesthesia). Technological advancements will make it easier to read vital life signs in a person and help better decide the specific dosages a person needs.