Cardiomyopathy Essay

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Choice “D” is the best answer choice. Patients with restrictive cardiomyopathy (RCM) often present at an advanced stage of disease with the pronounced cardiopulmonary symptoms of CHF. Patients usually complain of gradually worsening shortness of breath, progressive exercise intolerance, and fatigue. Fatigue and weakness are results of decreased stroke volume and cardiac output. Paroxysmal nocturnal dyspnea may be reported. Right-sided congestive features are often prominent and patients may have distention of the abdomen secondary to ascites, and frequently have profound bilateral peripheral edema. Abdominal discomfort or liver tenderness may be reported. Chest pain secondary to angina or chest pain mimicking myocardial ischemia can be observed, …show more content…

Blood pressure may fall further on standing, particularly if autonomic neuropathy is present. Hypertension is unusual, and in patients with a history of hypertension, “spontaneous” resolution of hypertension over the preceding few months is common. Pulmonary exam reveals bilateral pleural effusions, but rales are rarely present, even in association with advanced heart failure. The pleural effusions in a patient with AL amyloidosis may simply represent heart failure, but patients with cardiac amyloid may also have pleural infiltration with amyloid, resulting in disproportionately large effusions that are diuretic resistant and rapidly recur after a pleural tap. Splenomegaly is rare, whereas hepatomegaly is common and is due either to congestion from right heart failure or to amyloid infiltration When extensive amyloid infiltration of the liver is present, the organ is rock-hard and not tender, often extending several centimeters below the costal margin and crossing the midline. This contrasts with the firm, sometimes tender, liver of heart failure. Peripheral edema may be profound, and if it appears disproportionate to the degree of heart failure, the possibility of associated nephrotic syndrome should be considered. In addition to autonomic dysfunction, amyloidosis may cause a sensory neuropathy, and the patient may complain of numbness or painful extremities/ A history of weight loss is common, and proteinuria, frequently reaching nephrotic range (≥3 g/24 h), coexists with cardiac disease in 30% to 50% of

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