java barcode reader api C Diagnostic Studies in Objective-C

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C Diagnostic Studies
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An echocardiogram is indicated to exclude unsuspected valvular or other lesions and confirm the presence of dilated cardiomyopathy and reduced systolic function (as opposed to diastolic heart failure) Mitral Doppler inflow patterns also help in the diagnosis of associated diastolic dysfunction Color flow Doppler can reveal tricuspid or mitral regurgitation, and continuous Doppler can help define PA pressures Exercise or pharmacologic stress myocardial perfusion imaging may suggest the possibility of underlying coronary disease Radionuclide ventriculography provides a noninvasive measure of the EF and both RV and LV wall motion Cardiac MRI is particularly helpful in infiltrative processes, such as sarcoidosis or hemochromatosis, and is the diagnostic study of choice for RV dysplasia MRI can also help define an ischemic etiology by noting gadolinium enhancement consistent with myocardial scar Cardiac catheterization is seldom of specific value unless myocardial ischemia or LV aneurysm is suspected The serum ferritin is an adequate screening study for hemochromatosis The erythrocyte sedimentation rate may be low due to liver congestion The serum level of BNP or pro-BNP can be used to help quantitate the severity of CHF
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Clinical Findings
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A Symptoms and Signs
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In most patients, symptoms of heart failure develop gradually Cardiomyopathy may be recognized because of asymptomatic cardiomegaly or ECG abnormalities, including arrhythmias The initial presentation may be severe left or biventricular failure The physical examination reveals rales, an elevated JVP, cardiomegaly, S3 gallop rhythm, often the murmurs of functional mitral or tricuspid regurgitation, peripheral edema, or ascites In severe CHF, Cheyne-Stokes breathing, pulsus alternans, pallor, and cyanosis may be present
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Treatment
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Standard therapy for heart failure should include ACE inhibitor, -blockers, diuretics, and an aldosterone antagonist Digoxin is a second-line drug but remains favored as an adjunct by some clinicians Calcium channel blockers should generally be avoided Sodium restriction is helpful, especially in acute cardiomyopathy When atrial fibrillation is present, heart rate control is important if sinus rhythm cannot be established or maintained Many patients may now be candidates for cardiac synchronization therapy with biventricular pacing and an implantable defibrillator Few cases of cardiomyopathy are amenable to specific therapy for the underlying cause Alcohol use should be discontinued There is often marked recovery of cardiac function following a period of abstinence in alcoholic cardiomyopathy Endocrine causes (thyroid dysfunction, acromegaly, and pheochromocytoma) should be treated Immunosuppressive therapy is not indicated in chronic dilated cardiomyopathy The management of CHF is outlined in the section on heart failure
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Presents as an acute anterior myocardial infarction, but coronaries normal at cardiac catheterization ECG often with deep anterior T wave inversion Imaging reveals apical left ventricular ballooning due to anteroapical stunning of the myocardium
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General Considerations
LV apical ballooning can follow a high catecholamine stress The resulting shape of the LV suggests a rounded ampulla form similar to an octopus pot (takotsubo pot) The acute myocardial injury that occurs is more common in postmenopausal women It has been described following some stressful event, such as hypoglycemic, lightning strikes, earthquakes, postventricular tachycardia, during alcohol withdrawal, following surgery, during hyperthyroidism, and following emotional stress
Clinical Findings
A Symptoms and Signs
The symptoms are similar to any acute coronary syndrome Typical angina and dyspnea is usually present Syncope is rare
Prognosis
The prognosis of dilated cardiomyopathy without clinical heart failure is variable, with some patients remaining stable, some deteriorating gradually, and others declining rapidly Once heart failure is manifest, the natural history is similar to that of other causes of heart failure, with an annual mortality around 11 13% Arterial and pulmonary emboli are more common in dilated cardiomyopathy than in ischemic cardiomyopathy Suitable candidates may benefit from long-term anticoagulation, and all patients with atrial fibrillation should be so treated Some patients may be candidates for cardiac transplantation
Ardehali H et al Endomyocardial biopsy plays a role in diagnosing patients with unexplained cardiomyopathy Am Heart J 2004 May;147(5):919 23 [PMID: 15131552] Burkett EL et al Clinical and genetic issues in familial dilated cardiomyopathy J Am Coll Cardiol 2005 Apr 5;45(7):969 81 [PMID: 15808750] Felker GM et al Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy N Engl J Med 2000 Apr 13;342(15):1077 84 [PMID: 10760308] Maisch B et al Dilated cardiomyopathies as a cause of congestive heart failure Herz 2002 Mar;27(2):113 34 [PMID: 12025458] Sen-Chowdhry S et al Arrhythmogenic right ventricular cardiomyopathy: clinical presentation, diagnosis, and management Am J Med 2004 Nov 1;117(9):685 95 [PMID: 15501207]
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