CARDIOMYOPATHY-FAB AFIQ

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Cardiomyopathy

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Primary abnormalities of ventricular muscle are characterized as cardiomyopathies . Can be classify into: Dilated Restrictive Hypertrophic

Dilated cardiomyopathy :

Dilated cardiomyopathy Patients have enlarged heart, as defined by PE, CXR or echocardiogram. The cardiomegaly is due to left ventricular cavity enlargement, and there is usually normal or reduced left ventricular thickness . The left ventricular contractility, as judged by ejection fraction, is reduced to below 40%, and diastolic relaxation becomes abnormal as myocyte dysfunction and fibrosis develop.

causes:

causes 10% of it is known (causes of cngstve HF) Others are idiopathic, could be Toxic (alcohol, doxorubicin) Infection (viral, parasitic, and others) Collagen vascular disease Ischemic?

C(X):

C(X) Systemic embolization occurs in 10-15% of patients as a result of cardiomegaly , decreased contractility, sluggish blood flow, and atrial or ventricular arrhythmias . M(x) Reduce LVH or else poor prog .(5 yrs)

Hypertrophic cardiomyopathy:

Hypertrophic cardiomyopathy Hypertrophic obstructive cardiomyopathy (HOCM) idiopathic hypertrophic subaortic stenosis (IHSS) asymmetrical septal hypertrophy (ASH)

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Hypertrophic cardiomyopathy infers a primary muscle disorder, and not hypertrophy, in response to hypertension or valvular outflow obstruction. Many cases are inherited in an autosomal dominant pattern.

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There is markedly increased ventricular wall thickness and decreased left ventricular cavity size . The abnormal wall thickness may be symmetric or asymmetric, affecting the septum more severely than the posterior wall. The hypertrophic heart is hyperdynamic in contractility , ejecting the major portion of the stroke volume early in systole. Diastolic relaxation , however, is slow and often incomplete , and diastolic filling pressures are elevated.

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The excessively thick left ventricular wall and low output may result in symptoms of myocardial ischemia even without atherosclerotic coronary heart disease. Average age of diagnosis : Mid twenties.

Restrictive cardiomyopathy:

Restrictive cardiomyopathy Both the thickness of the cardiac muscle and cavity size are usually normal until late in the course of disease, when both may increase diastolic relaxation is the primary hemodynamic abnormality Ventricular compliance is markedly decreased, resulting in an elevation in diastolic filling pressures and limited ventricular filling Ultimately, as the disease progresses, systemic contractility is decreased and heart failure symptoms worsen

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Causes Amyloidosis Sarcoidosis Hemochromatosis These infiltrative disease states can be proved by biopsy of any clinically involved organ, and endomyocardial biopsy can be used to establish the diagnosis or document cardiac involvement.

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LV wall LV cavity Systolic contractility Diastolic compliance Dilated Thin Large  N @  Hypertrophic thick small   Restrictive N N N @  

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