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
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- 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.
