Hospital pediatrics. Cardiomyopocia in children (most important)

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Hospital pediatrics. Cardiomyopocia in children (most important)

Lecture notes, cheat sheets

Directory / Lecture notes, cheat sheets

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7. Cardiomyopia in children

Classification of cardiomyopathies:

1) dilated (DCMP);

2) hypertrophic (HCMP);

3) restrictive (RCMP);

4) arrhythmogenic right ventricle (AKMP).

Dilated cardiomyopathy represents a sharp expansion of the cavity of the ventricles, especially the left one.

Clinical manifestations. At any age, in any gender (more often in men), signs of heart failure (up to total), decreased blood pressure, expansion of the boundaries of the heart, cardiomegaly.

Auscultatory: deafness of the XNUMXst tone at the apex, bifurcation, gallop rhythm. Respiratory organs: tympanitis or dullness on the right, on the left - small bubbling wet rales.

Diagnostics.

ECG tachycardia, arrhythmia, the appearance of R wave and ("-") T wave; FCG - I tone weakened, systolic, proto-diastolic murmur; EchoCG - dilatation of all parts of the heart, EchoCG - dilatation of the cavity of the left ventricle (KDDlzh = 56 mm), decrease in myocardial contractility (fr. ejection 0,34), EchoCG - symmetric myocardial hypertrophy Tzspzh = Tmzhp = 28, mitral regurgitation.

Treatment. Principles of treatment.

I. Conservative.

1. ACE inhibitors (capoten, enalapril, renitek).

2. Angiotensin-2 receptor blockers (Cozaan, Diovan).

3. Diuretics.

4. β-blockers (carvediol).

5. Antiaggregants, anticoagulants. II. Surgical.

Hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy is expressed by hypertrophy of the left ventricle and interventricular septum.

Clinical manifestations. More often in boys, there are familial forms, shortness of breath, pain in the heart, expansion of the borders of the heart, weakening of the first tone at the apex, emphasis of the second tone over the pulmonary artery, variable systolic-diastolic murmur along the left edge of the sternum, development of cardiovascular failure of the left ventricular type.

Diagnostics. ECG - signs of hypertrophy of the left atrium and left ventricle; the Q wave is changed in holes II-III, V4, V6.

EchoCG - thickening of the interventricular septum, a decrease in the volume of the left ventricle. X-ray examination of the chest - depends on the size of the heart, the displacement of the mitral valve forward.

Carnitine CMP

Ventricular hypertrophy: KDDlzh = 65 mm, atriomegaly, EF = 0,2, mitral regurgitation II-III degree.

Treatment. Surgical - septal myectomy.

1. Valve prosthetics - two-chamber constant stimulation.

2. Conservative:

1) limitation of physical activity;

2) diet with restriction of salt and water;

3) ?-blockers;

4) Ca-channel blockers;

5) antiarrhythmics of other groups;

6) ACE inhibitors.

Cardiac glycosides are contraindicated in HCM.

Author: Pavlova N.V.

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