Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content +++ KEY FEATURES +++ ESSENTIALS OF DIAGNOSIS ++ Body mass index > 30 kg/m2 Increased left ventricular mass by imaging in the absence of hypertension or diabetes Heart failure and cardiac arrhythmias common +++ GENERAL CONSIDERATIONS ++ Obesity is not only a risk factor for coronary artery disease, but can also cause left ventricular hypertrophy, heart failure, and arrhythmias independent of hypertension Fatty infiltration of the conduction system and sleep apnea have been found in obese individuals; both can lead to arrhythmias Eccentric left ventricular hypertrophy may be related to increased plasma volume and metabolic demands Obesity is also part of the metabolic syndrome, which predisposes to atherosclerosis +++ CLINICAL PRESENTATION +++ SYMPTOMS AND SIGNS ++ Dyspnea and fatigue are common Chest pain and palpitations can occur +++ PHYSICAL EXAM FINDINGS ++ Increased body mass index: – Obese > 30 kg/m2 Central (truncal or android) obesity (waist circumference > 102 cm men, > 88 cm women) is a risk factor for atherosclerosis Lower body (gynecoid) obesity is not a risk factor for coronary artery disease Systemic hypertension Left ventricular lift or heave Signs of heart failure may be present S3 or S3 may be present +++ DIFFERENTIAL DIAGNOSIS ++ Coronary artery disease Dilated cardiomyopathy Hypertrophic cardiomyopathy Diabetic cardiomyopathy +++ DIAGNOSTIC EVALUATION +++ LABORATORY TESTS ++ Elevated lipids Abnormal liver function tests from fatty accumulation +++ ELECTROCARDIOGRAPHY ++ Prolonged QTc +++ IMAGING STUDIES ++ CT and MRI: useful to confirm excess internal fat accumulation Echocardiography: – Shows left ventricular hypertrophy, usually eccentric but sometimes concentric – Evidence of systolic or diastolic dysfunction may be present +++ DIAGNOSTIC PROCEDURES ++ Underwater weighing for determination of lean body mass Skinfold thickness measures with calipers Sleep study to detect sleep apnea +++ TREATMENT +++ CARDIOLOGY REFERRAL ++ Suspected cardiac disease Difficult to control hypertension +++ HOSPITALIZATION CRITERIA ++ Heart failure Respiratory failure Planned procedure or surgery +++ MEDICATIONS ++ Weight loss through diet, exercise, and approved drugs Assessment and treatment of comorbid conditions, such as hyperlipidemia, sleep apnea, and hypertension Indicated treatment for heart failure or arrhythmias +++ SURGERY ++ Bariatric surgery in selected cases +++ MONITORING ++ ECG in hospital as appropriate Daily weight +++ DIET AND ACTIVITY ++ Diet of 500–1000 kcal/day: 30% total fat, 7% saturated fat Aerobic exercise for at least 30 minutes a day +++ ONGOING MANAGEMENT +... GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessCardiology 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessCardiology Full Site: One-Year Individual Subscription $595 USD Buy Now View All Subscription Options