Essay on What´s Dilated Cardiomyopathy?

Essay on What´s Dilated Cardiomyopathy?

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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.

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