cardiomyopathies
DESCRIPTION
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 : - PowerPoint PPT PresentationTRANSCRIPT
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:Diastolic dysfunction
Due to- LV obstruction.- arrhythmias
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 gradient2- ECG: LVH & ST and T wave changes
Treatment :1. Beta blockers to reduce LV contractility
and thus reduce the outflow obstruction2. Verapamil : that improve the diastolic
function3. Amiodarone : anti-arrhythmic drug4. Surgical excision : of part of the bulging
interventricular septum .5. 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 dysfunction2. Endomyocardial biopsy. Treatments : small doses of diuretic