Cardiomyopathy

Cardiomyopathy . It is an extraordinarily heterogeneous set of processes that only have in common that affect the cardiac muscle and that cause a wide spectrum of forms of cardiac dysfunction.

Summary

[ hide ]

  • 1 Classification
    • 1 A-Functional Classification of Cardiomyopathies:
    • 2 B- Specific cardiomyopathies:
  • 2 Etiopathogenesis
  • 3 Clinical manifestations
  • 4 Physical exam
  • 5 Pathological anatomy
    • 1 Macroscopically
    • 2 Microscopically
  • 6 Diagnosis
  • 7 Complementary exams
  • 8 General support measures
  • 9 Factors of poor prognosis of Cardiomyopathies.
    • 1 Clinician
    • 2 Electrocardiographically
    • 3 Ventriculographic
    • 4 Hemodynamic
    • 5 Stress test
    • 6 Biochemist
  • 10 Sources
  • 11 External links

Classification

Cardiomyopathy can be classified taking into account different criteria

A-Functional classification of cardiomyopathies:

  • Dilated cardiomyopathy.
  • Hypertrophic cardiomyopathy.
  • Restrictive cardiomyopathy.
  • Arrhythmogenic Cardiomyopathy of the Right Ventricle.
  • Cardiomyopathies not classified.

B- Specific cardiomyopathies:

  • Ischemic cardiomyopathy.
  • Valvular cardiomyopathy.
  • Hypertensive cardiomyopathy .
  • Inflammatory cardiomyopathy.
  • Metabolic cardiomyopathy.
  • Systemic Diseases.
  • Muscular dystrophies.
  • Neuro-muscular disorders.
  • Hypersensitivity reactions intoxications.
  • Peripartum cardiomyopathy.

Etiopathogenesis

  • Genetic and family factors.
  • Chronic viral myocardial infections.
  • Abnormalities in immune function.

Clinical manifestations

  • First medical attention between 20-50 years.
  • The most frequent form of presentation is progressive heart failure (HF).
  • Other presentations: arrhythmias, thromboembolism and syncope.
  • Early symptoms of HF can be subtle (fatigue and weakness secondary to low cardiac output).
  • The most important symptoms correspond to left HF: progressive exertional dyspnea, orthopnea and paroxysmal nocturnal dyspnea.
  • Onset of symptoms can be gradual, progressing over a period of months or years, or abruptly, precipitated by an acute respiratory infection or a flu-like process.
  • Symptoms of right HF: abdominal bloating (ascites), pain in the right hypochondrium, nausea may be confused with chronic liver disease or biliary disease.
  • More than 30% suffer from chest pain in the absence of relevant coronary artery disease.
  • In a small percentage of cases, the debut is usually a pulmonary or systemic embolism.

Physical exam

  • The findings depend on the stage of the disease.
  • With the development of the state of low cardiac output appear all the symptoms of chronic heart failure.
  • AT (normal, low, narrow differential.
  • Alternating pulse.
  • Signs of right heart failure tricuspid regurgitation (hepatomegaly, ascites, lower limb edema).
  • Diffuse laterally displaced apical shock.
  • Paradoxical splitting of the second noise (Complete left bundle branch block).
  • Atrial gallop (4 heart rate) in the absence of Atrial Fibrillation.
  • Ventricular gallop (3 heart tone) in decompensation states.
  • Mitral and / or tricuspid regurgitation murmurs.
  • Pulmonary examination (lung dullness, crackles).

Pathological anatomy

Macroscopically

  • Dilation of the four cavities.
  • Increased wall thickness.
  • Normal heart valves.
  • Intracavitary thrombi.

Microscopically

  • Presence of hypertrophic and dead myocytes replaced by fibrosis with variable involvement of the electrical conduction system.
  • Myocytic atrophy.
  • Loss of myofilaments.

Diagnosis

  • Clinical examination.
  • Chest x-ray.

Complementary exams

  • Thyroid stimulating hormone levels.
  • Calcium and Phosphorus .
  • HIV
  • Chagas test.
  • Isotopic Ventriculography.
  • Positron emission tomography.
  • Endomyocardial biopsy.
  • Right heart catheterization.

General support measures

  • Sodium restriction
  • Weight control.
  • Tobacco and Alcohol Abstinence .
  • Maintain a level of physical activity that does not trigger symptoms.
  • Supervised aerobic exercises (beneficial metabolic and hemodynamic effects).

Poor prognosis factors for cardiomyopathies.

Clinical

  • NYHA Functional Class IV.
  • Advanced age.
  • Male gender.
  • Sincope Background .
  • Persistent third tone and gallop rhythm.
  • Signs of congestive heart failure.

Electrocardiographically

  • Atrial fibrillation.
  • Atrioventricular block I –II degree.
  • Complete left branch block.
  • Ventricular tachycardia.

Ventriculographic

  • Low left ventricular ejection fraction.
  • Large end-diastolic left ventricle.
  • Right ventricular dilation.
  • Spherical left ventricular geometry.
  • Diffuse alteration of the motility of the ventricular wall.
  • Decrease in the relationship between mass and ventricular volume.

Hemodynamic

  • Pulmonary capillary pressure> 20mmhg.
  • Cardiac index <2,5ltros / min. / M2 SC.
  • Lower mean blood pressure.
  • Elevated right atrial pressure.

Stress test

  • Maximum O2 consumption <12ml / Kg. / Min.

Biochemical

  • High norepinephrine levels.
  • High adrenaline levels
  • High angiotensin II levels
  • High atrial natriuretic factor levels.

Leave a Comment