Cardiomyopathies

Cardiovascular Review Section of NCCPA Blue Print

Dilated Cardiomyopathy

-Defined as being characterized by enlargement of chambers and impaired systolic function.

-Can involved one or both ventricles

-Causes

-Genetic

-Thyrotoxicosis

-Metabolic (Starvation)

-Peri or Post partum

-Cobalt ingestion

-Sarcoidosis

-Hemochromatosis

-Radiation

-Thiamine Deficiency

-Alcohol

-Catecholamine induced

-Infectious (Viral and Parasitic)

-Radiation

-Big Picture-can be idiopathic but can be caused by ingestion of toxins, radiation, infection, or       

metabolic disorders

-Physical Exam similar to a patient with heart failure

-EKG may show some LVH or RVH

-ECHO is necessary for diagnosis 

-Cardiac biopsy only for those who may have treatable cause

-Treatment is similar to heart failure targeted at increasing preload and decreasing after  load.  

-ACE inhibitors and Beta Blockers are ideal for those patients who can tolerate them

Hypertrophic Cardiomyopathy

-Has normal or small left ventricle size

-Involves a disproportionate thickening of the inter-ventricular septum

-causes outflow obstruction and diastolic disfunction

-Mainly an autosomal dominant cause

-can cause life threatening arrhythmias 

-can be asymptomatic

-most common symptom is dyspnea on exertion

-May have exertion chest pain from outflow obstruction rather than coronary artery disease

-Syncope or dizziness may be present

-can cause life threatening arrhythmias 

-can be asymptomatic

-most common symptom is dyspnea on exertion

-May have exertion chest pain from outflow obstruction rather than coronary artery disease

-Syncope or dizziness may be present

-Physical Findings-crescendo-decrescendo systolic murmur

-S4 gallop from increased ventricular stiffness

-Can hear an S3 if left ventricular systolic problems

-ECHO is needed for diagnostic confirmation and to determine the severity

-May need cath to rule out concomitant coronary artery disease

-Treatment is targeted at improving diastolic disfunction

-Calcium channel blockers are ideal

-Beta blockers can be used to

-These increase preload and allow the ventricle to fill better

Restrictive Cardiomyopathy

-has a small ventricle size

-may involve one or two ventricles

-characterized by diastolic dysfunction

-Elevated ventricular filling pressures

-Systolic function normal

-Most common causes is amyloidosis

-Can be idiopathic

-Can be caused by Sarcoidosis, Hemochromatosis, Radiation, scleroderma, Gaucher’s disease

-Physical exam-signs of  right heart failure are present

-Elevated right side heart pressures and dilated neck veins

-ECHO is needed in the diagnosis 

-Right heart cath sometimes needed to make sure it is not constrictive pericarditis

-Treatment is similar to heart failure

-Diuretics help decrease systemic vascular resistance

Cardiomyopathy Summary

-Dilated Cardiomyopathy-systolic disfunction, may affect one or both ventricles.  Symptoms similar to CHF.  Dilated chambers

-Hypertrophic Cardiomyopathy-diastolic problem, small chambers can cause outflow obstruction.  Can cause DOE or chest pain with activity

-Restrictive Cardiomyopathy-diastolic problem, elevated right heart pressures, amyloidosis most common cause, treatment similar to heart failure