2. IntroductionIntroduction
2006 AHA defined cardiomyopathies as “a heterogeneous group
of diseases of the myocardium associated with mechanical &/or
electrical dysfunction that usually exhibit inappropriate
ventricular hypertrophy or dilatation and are due to a variety of
causes that frequently are genetic.”
Cardiomyopathies either are confined to the heart or are a part
of generalized systemic disorders
3. disease of the heart muscle in which the heart loses its ability to
pump blood effectively
the heart muscle becomes enlarged or abnormally thick or rigid.
In rare cases, the muscle tissue in the heart is replaced with scar
tissue.
As cardiomyopathy progresses the heart becomes weaker and
less able to pump blood through the body to heart failure,
arrhythmias, systemic and pulmonary edema and, more rarely,
endocarditis
The 3 main types of cardiomyopathy are:
Dilated cardiomyopathy
Hypertrophic cardiomyopathy
Restrictive cardiomyopathy
CardiomyopathyCardiomyopathy
5. Major Risk FactorsMajor Risk Factors
Having a family history of cardiomyopathy, heart failure, or sudden
cardiac death
Having a disease or condition that can lead to cardiomyopathy, such
as:
Coronary artery disease
A previous heart attack
Myocarditis
Diseases that can damage the heart (for example, hemochromatosis,
sarcoidosis, or amyloidosis)
Long-term alcoholism
Long-term high blood pressure
Diabetes and other metabolic diseases
8. DefinitionDefinition
Primary (idiopathic) is a disease of unknown etiology that
principally affects the myocardium leading to LV dilation and
systolic dysfunction
Most common of the cardiomyopathies
9. DCM - Incidence and PrognosisDCM - Incidence and Prognosis
most common form of cardiomyopathy
generally occurs in adults aged 20 to 60 years
more common in men
Prevalence is 36 per 100,000 population
Third most common cause of heart failure
Most frequent cause of heart transplantation
Complete recovery is rare
50% die within 2yrs and 25% survive longer than 5yrs
11. Dilated CardiomyopathyDilated Cardiomyopathy
the heart muscle begins to dilate or stretch and become thinner
Ventricular chamber size
over time, the heart becomes weaker heart failure
symptoms of heart failure: fatigue, edema
can also lead to heart valve problems (regurgitation),
arrhythmias, and blood clots in the heart (poor blood flow),
a common reason for needing a heart transplant.
12.
13. Types and Causes:Types and Causes:
Ischemic cardiomyopathy - caused by CAD & MI , w/c leave
scars in the heart muscle
Idiopathic cardiomyopathy - the cause is unknown.
Hypertensive cardiomyopathy - seen in people who have high BP
for a long time, particuarly when it has gone untreated for
years.
Infectious cardiomyopathy - HIV, viral myocarditis
Alcoholic cardiomyopathy - usually begins about 10 years after
sustained, heavy alcohol consumption.
Toxic cardiomyopathy – due to cocaine, amphetamines, and some
chemotherapy drugs (doxorubicin, daunorubicin)
Peripartum cardiomyopathy: This type appears in women during
the last trimester of pregnancy or after childbirth.
Radiotherapy (cobalt)
diabetes and thyroid disease
14. HypertrophicHypertrophic
CardiomyopathyCardiomyopathy
occurs when the heart muscle thickens abnormally (left
ventricle)
1.) obstructive type - the septum thickens and bulges into the
left ventricle blocks the flow of blood into the aorta the
ventricle must work much harder to pump blood past the
blockage and out to the body
- symptoms can include chest pain, dizziness, shortness of
breath, or fainting.
- can also affect the mitral valve, causing blood to leak
backward through the valve.
2.) non-obstructive type - the entire ventricle may become
thicker (symmetric ventricular hypertrophy) or it may
happen only at the bottom of the heart (apical hypertrophy).
The right ventricle also may be affected.
18. Pathophysiology:
Left ventricular hypertrophy (thick ventricular wall)
ventricular chamber size hold less blood CO
pressure in the atrium and lungs
changes in the cardiac muscles interfere with the heart's
electrical signals, leading to arrhythmias sudden cardiac arrest
Causes:
inherited because of a gene mutation
develop over time because of high blood pressure or aging
often, the cause is unknown.
Hypertrophic CardiomyopathyHypertrophic Cardiomyopathy
19.
20. Restrictive CardiomyopathyRestrictive Cardiomyopathy
tends to mostly affect older adults
the ventricles become stiff and rigid due to replacement of the
normal heart muscle with abnormal tissue, such as scar tissue.
As a result, the ventricles cannot relax normally and expand to fill
with blood, which causes the atria to become enlarged.
Eventually, blood flow in the heart is reduced, and complications
such as heart failure or arrhythmias occur.
Causes:
radiation treatments, infections, or scarring after surgery
Hemochromatosis - a condition in which too much iron is deposited
into tissues, including heart tissue
Amyloidosis, a disease in which abnormal proteins are deposited into
heart tissue
Sarcoidosis, a disease in which inflammation produces tiny lumps of
cells in various organs in the body, including the heart
23. Signs and SymptomsSigns and Symptoms
some have no symptoms in the early stages of the disease
as cardiomyopathy progresses and the heart weakens, signs and
symptoms of heart failure usually appear.
These signs and symptoms include:
Tiredness
Weakness
Shortness of breath after exercise or even at rest
Swelling of the abdomen, legs, ankles, and feet
Other signs and symptoms: dizziness, lightheadedness, fainting during
exercise, abnormal heart rhythms, murmurs
27. InterventionsInterventions
The main goals of treating cardiomyopathy are to:
Manage any conditions that cause or contribute to the
cardiomyopathy
Control symptoms so that the person can live as normally as possible
Stop the disease from getting worse
Reduce complications and the chance of sudden cardiac death
Medications:
Diuretics, which remove excess fluid and sodium from the body.
Angiotensin-converting enzyme (ACE) inhibitors, which lower blood
pressure and reduce stress on the heart.
Beta-blockers, which slow the heart rate by reducing the speed of
the heart's contractions. These medicines also lower BP
Calcium channel blockers, which slow a rapid heartbeat by reducing
the force and rate of heart contractions, decrease BP
28. MedicationsMedications
Digoxin - increases the force of heart contractions and slows
the heartbeat.
Anticoagulants, which prevent blood clots from forming.
Anticoagulants are often used in the treatment of dilated
cardiomyopathy.
Antiarrhythmia medicines, which keep the heart beating in a
normal rhythm.
Antibiotics, which are used before dental or surgical procedures.
Antibiotics help to prevent endocarditis, an infection of the heart
walls, valves, and vessels.
Corticosteroids, which reduce inflammation.
29. SurgerySurgery
Septal myectomy
- also called septal myomectomy
- is open-heart surgery for hypertrophic obstructive
cardiomyopathy
- generally used in younger patients and when medicines aren't
working well.
Procedure:
1. a surgeon removes part of the thickened septum that is bulging
into the left ventricle this widens the pathway in the
ventricle that leads to the aortic valve and improves blood flow
through the heart and out to the body
2. If necessary, the mitral valve can be repaired or replaced at the
same time. This surgery is often successful, and the person can
return to a normal life with no symptoms.
30. Surgery (cont.)Surgery (cont.)
Surgically implanted devices.
- Surgeons can place several different types of devices in the
heart to help it beat more effectively.
1. A left ventricular assist device (LVAD)
- helps the heart pump blood to the body
- LVAD can be used as a long-term therapy or as a short-term
treatment for people who are waiting for a heart transplant.
2. An implantable cardioverter defibrillator (ICD)
- is used in people who are at risk of life-threatening arrhythmia
or sudden cardiac death.
- This small device is implanted in the chest and connected to
the heart with wires. If the ICD senses a dangerous change in
heart rhythm, it will send an electric shock to the heart to
restore a normal heartbeat.
Heart Transplant
33. Lifestyle ChangesLifestyle Changes
The doctor may recommend lifestyle changes to manage a condition
that is causing the cardiomyopathy. These changes may help reduce
symptoms. Lifestyle changes may include:
Quitting smoking
Losing excess weight
Eating a low-salt diet
Getting moderate exercise, such as walking, and avoiding strenuous
exercise
Avoiding the use of alcohol and illegal drugs
Getting enough sleep and rest
Reducing stress
Treating underlying conditions, such as diabetes and high blood
pressure
34. Heart TransplantHeart Transplant
an operation in which the diseased heart in a person is replaced with
a healthy heart from a deceased donor.
90% of heart transplants are performed on patients with end-stage
heart failure --- condition has become so severe that all
treatments, other than heart transplant, have failed.
Survival rates:
88 % of patients survive the first year after transplant
72 % survive for 5 years
50 % survive for 10 yrs.
16 % survive 20 years.
35. Patients who might not be candidates for heart transplant
surgery, because the procedure is less likely to be successful.
Advanced age - most transplant surgery isn't performed on
patients older than 70 years.
Poor blood circulation throughout the body, including the brain.
Diseases of the kidney, lungs, or liver that can't be reversed.
History of cancer or malignant tumors.
Inability or unwillingness to follow lifelong medical instructions
after a transplant.
Pulmonary arterial hypertension (high blood pressure in the
lungs) that can't be reversed.
Active infection throughout the body.
Heart Transplant (cont.)Heart Transplant (cont.)
36. Organs are matched for blood type and size of donor and recipient.
The Donor Heart
Guidelines on how a donor heart is selected :
the donor meet the legal requirement for brain death
consent forms are signed
younger than 65 years of age
have little or no history of heart disease or trauma to the chest
not exposed to hepatitis or HIV
donor heart must be transplanted w/in 4 hrs. after removal from
the donor
Heart Transplant (cont.)Heart Transplant (cont.)
38. A bypass machine is hooked up to the arteries and veins of the
heart. The machine pumps blood through the patient's lungs and
body while the diseased heart is removed and the donor heart is
sewn into place.
Preventing Rejection
Immunosuppressants used: cyclosporine, tacrolimus, MMF
(mycophenolate mofetil), and steroids such as prednisone.
Watching for Signs of Rejection
Shortness of breath
Fever
Fatigue
Weight gain
Reduced amounts of urine
Preventing Infection
Heart Transplant (cont.)Heart Transplant (cont.)
39. What Are the Risks of a HeartWhat Are the Risks of a Heart
Transplant?Transplant?
Failure of the donor heart
Primary Graft Dysfunction
Rejection of the Donor Heart
Cardiac Allograft Vasculopathy - the walls of the new heart's
coronary arteries become thick, hard, and lose their elasticity.
- can cause heart attack, heart failure, dangerous arrhythmias,
and sudden cardiac arrest
Complications from medicines - risk of infection, diabetes,
osteoporosis , high blood pressure, kidney damage, and cancer
Infection
Cancer – lymphoma and skin cancer (due to suppression of the
immune system)
40.
41. 1. disease of the heart muscle in which the heart loses its ability to pump blood
effectively:-
a)Mitral stenosis
b)Atherosclerosis
c)Cardiomyopathy
d)IHD
2. Type of cardiomyopathy in which the heart muscle begins to dilate or
stretch and become thinner is known as:-
a)Dilated cardiomyopathy
b)Restricted cardiomyopathy
c)Hypertrophic Cardiomyopathy
d)non of the above
42. 3. Which is the not cause of cardiomyopathy:
a. Myocarditis
b. Long-term alcoholism
c. Long-term high blood pressure
d. Arthritis
43. 4. The type of cardiomyopathy which cause the Systolic dysfunction is:-
a) Dilated cardiomyopathy
b) Restricted cardiomyopathy
c) Hypertrophic Cardiomyopathy
d) non of the above
5. The sign and symptoms of cardiomyopathy are:-
a)Shortness of breath after exercise or even at rest
b)Swelling of the abdomen, legs, ankles, and feet
c)heart rhythms and murmurs
d)All of the above
--prevalence of DCM maybe underestimated since so many patients with DCM are asymp
Hypertrophy may involve any portion of ventricle:
ASH in > 90%
symmetric hypertrophy
apical hypertrophy
Myocardial fiber disarray -
diastolic dysfunction, with
impaired LV relaxation and decreased LV compliance.
Coronary Arteries
intramyocardial arteries with intimal and medial hypertrophy
decreased luminal area ischemia
