Cardiomyopathy
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Transcript of Cardiomyopathy
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Cardiomyopathy
Dr. Gerrard Uy
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Cardiomyopathy
• a condition primarily involving the myocardium
• not the result of congenital, acquired valvular, hypertensive, coronary arterial, or pericardial abnormalities
• 2 forms:– Primary type– Secondary type
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Primary cardiomyopathy
• consisting of heart muscle disease predominantly involving the myocardium and/or of unknown cause
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Secondary cardiomyopathy
• consisting of myocardial disease of known cause or associated with a systemic disease such as amyloidosis or chronic alcohol use
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three morphologic types
• dilated, restrictive, and hypertrophic
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three morphologic types • 1. Dilated: Left and/or right ventricular
enlargement, impaired systolic function, congestive heart failure, arrhythmias, emboli
• 2. Restrictive: Endomyocardial scarring or myocardial infiltration resulting in restriction to left and/or right ventricular filling
• 3. Hypertrophic: Disproportionate left ventricular hypertrophy, typically involving septum more than free wall, with or without an intraventricular systolic pressure gradient; usually of a nondilated left ventricular cavity
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Dilated cardiomyopathy
• 1/3 of all cases• LV and/or right ventricular (RV) systolic pump
function is impaired, leading to progressive cardiac dilatation (remodeling)
• Symptoms of heart failure (HF) typically appear only after remodeling has been ongoing for some time (months or even years)
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Dilated cardiomyopathy
• In most cases, no cause is apparent• Familial• end result of myocardial damage • may be the late consequence of acute viral
myocarditis • most commonly becomes apparent clinically
in the third or fourth decades• reversible form of DCM may be found with
alcohol abuse, thyroid disease, cocaine use and chronic uncontrolled tachycardia
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Dilated cardiomyopathy
CLINICAL FEATURES• Symptoms of left- and right-sided CHF usually
develop gradually • vague chest pain may be present• Syncope due to arrhythmias and systemic
embolism (often emanating from a ventricular thrombus) may occur
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Dilated cardiomyopathy
PHYSICAL EXAMINATION• Variable degrees of cardiac enlargement • findings of Congestive heart failure
• rales, edema
• pulse pressure is narrow • jugular venous pressure is elevated• 3rd and 4th heart sounds may occur
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Dilated cardiomyopathy
LABORATORY• Chest Xray– enlargement of the cardiac silhouette due to LV
dilatation– pulmonary vascular redistribution – alveolar edema
• ECG– Sinus tachycardia,atrial fibrillation, ventricular
arrhythmias, left atrial abnormality, low voltage, nssttwc
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Treatment
• Most patients die within 4 years• ¼ have spontaneous improvement• patients should be considered for chronic
anticoagulation• Standard therapy for heart failure• Alcohol should be avoided - cardiotoxic
effects
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Hypertrophic cardiomyopathy
• characterized by LV hypertrophy, typically of a nondilated chamber, without obvious cause
• 1 in 500 of the general population• pathophysiologic abnormality is diastolic
dysfunction
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Hypertrophic cardiomyopathy
• majority demonstrate a ventricular septum whose thickness is disproportionately increased when compared with the free wall
• half of all patients with HCM have a positive family history
• genetic testing may allow a definitive diagnosis of HCM
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Hypertrophic cardiomyopathy
CLINICAL FEATURES• Variable• asymptomatic or mildly symptomatic • first clinical manifestation may be SCD
(sudden cardiac death)• occurring in children and young adults during or after
physical exertion• most common cause of SCD in young competitive
athletes
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Hypertrophic cardiomyopathy
PHYSICAL EXAMINATION• hallmark of obstructive HCM is a systolic
murmur, which is typically harsh, diamond-shaped, and usually begins well after the first heart sound
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Hypertrophic cardiomyopathy
LABORATORY• ECG:
• LV hypertrophy and widespread deep, broad Q waves
• Chest Xray• May be normal or mild increase in silhouette
• Echocardiogram• Mainstay in diagnosis• LV hypertrophy, often with the septum 1.3 times the
thickness of the posterior LV free wall
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Hypertrophic Cardiomyopathy
TREATMENT• Competitive sports and very strenuous
activities should be proscribed• Dehydration avoided• Diuretics used in caution• Amiodarone appears to be effective in
reducing the frequency of supraventricular as well as of life-threatening ventricular arrhythmias
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Restrictive Cardiomyopathy
• Hallmark = abnormal diastolic function • walls are excessively rigid and impede ventricular
filling• Myocardial involvement with amyloid is a
common cause of secondary restrictive cardiomyopathy
• transplanted heart, in hemochromatosis, glycogen deposition, endomyocardial fibrosis, sarcoidosis, hypereosinophilic disease, and scleroderma
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Restrictive Cardiomyopathy
CLINICAL FEATURES– inability of the ventricles to fill limits cardiac
output and raises filling pressures– exercise intolerance and dyspnea – dependent edema, ascites, and an enlarged,
tender, and often pulsatile liver– heart sounds may be distant, and third and fourth
heart sounds are common
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Restrictive Cardiomyopathy
LABORATORY• ECG – low-voltage, nonspecific ST-T-wave abnormalities
and various arrhythmias
• Echocardiography, CTI, and CMRI – symmetrically thickened LV walls and normal or
slightly reduced ventricular volumes and systolic function