Download Cardiomyopathies

Cardiomyopathies
Dr. Hesham K. Rashid, MD
Ass. Professor of Cardiology
Benha University
 Definition : it is a disease of heart muscle of
unknown etiology.
 Types :
1. Dilated myopathy
2. Hypertrophic myopathy.
3. Restrictive myopathy
Dilated myopathy
 Etiology :
1. Primary : of unknown cause.
2. Secondary :
- generalized disease involving myocardium as
systemic lupus , beriberi , muscular dystrophies,
endocrine disorders as acromegaly.
- secondary to toxic effect of alcohol.
- secondary to toxic drugs as anticancer adriamycin
- puerperal cardiomyopathy occurs in late
pregnancy.
- ischemic myopathy due to infarction or ischemia
Effect
CLINICAL SYMPTOMS & SIGNS OF HEART FAILURE
 Clinical picture :
 Symptoms & signs of LV failure.
 Symptoms & signs of RV failure.
 Symptoms & signs of both LV & RV
Investigations
1- plain X-ray :
- cardiomegally.
- lung congestion
2- ECG :
- Sinus tachycardia.
- LBBB.
- Arrhythmias
3-Echocardiography
•Dilated LV .
•Impaired LV systolic functions
•Global hypokinisia
•LV thrombus can be seen
 Treatments :
 Treatment of underlining causes.
 Anti-failure treatment:
- Rest & salt restriction.
- Diuretics.
- ACE inhibitor.
- Digitalis.
- Oral anticoagulant
- Anti-arrhythmic drugs.
 Cardiac transplantation.
Hypertrophic cardiomyopathy
 Etiology : most cases are inherited as autosomal
dominant , some cases are sporadic
 Pathophysiology :
- disarray of cardiomyocytes ( inappropriate
hypertrophy of the myocardium ) leading to :
1- Ischemia 2- Arrhythmias 3- diastolic dysfunction
- asymmetric septal hypertrophy (ASH).
- LV outflow tract obstruction during systole.
- systolic anterior motion of mitral valve (SAM).
- Small LV with excellent systolic function.
SAM
ASH
Due to :
-Increase o2 consumption
- Hypertrophy of ms.kink
on coronary artery
Due to
- LV obstruction.
- arrhythmias
Due to:
Diastolic dysfunction
 Signs :
1. Jerky pulse (the pulse rapidly but stop suddenly).
2. Palpable & audible 4th heart
3. Systolic murmur due to :
- LV outflow obstruction at left sternal border
that increased with standing position or valsalva
- mitral regurge at the apex from abnormal mitral
valve
Investigations
1- Echocardiography:
* ASH
* SAM
* Thick LV with small cavity.
* Excellent systolic function with
marked impaired diastolic function
* variable dynamic pressure gradient
2- ECG: LVH & ST and T wave changes
 Treatment :
1. Beta blockers to reduce LV contractility and thus
2.
3.
4.
5.
reduce the outflow obstruction
Verapamil : that improve the diastolic function
Amiodarone : anti-arrhythmic drug
Surgical excision : of part of the bulging
interventricular septum .
Injection of alcohol in coronary artery which
supplies the IVS causing its infarction & atrophy.
Restrictive myopathy
 It occurs when myocardium becomes less
compliance and thus more difficult to distend
and fill making increase in the atrial pressure
( severe diastolic dysfunction ).
 Etiology :
infiltrative diseases of the myocardium as
amyloidosis , scleroderma , hemochromatosis.
 Symptoms :
1. Pulmonary congestive symptoms.
2. Systemic congestive symptoms
 Signs :
1. Congestive neck vein.
2. Fourth heart sounds.
 Investigations :
1. Echocardiography : diastolic dysfunction
2. Endomyocardial biopsy.
 Treatments : small doses of diuretic