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Transcript of Cardiomyopathy
Disease of the cardiac muscle
Can be subacute or chronic
Primary cardiomyopathy: when the cause is not known
Secondary cardiomyopathy: results from a disease process
Types of Cardiomyopathy
Arrhythmogenic Right Ventricular
DCM is a structural abnormality
Most common; twice as common among men as women
Diagnosis is most common in middle age
Extenisive damage to the myofibrils
Interferes with myocardial metabolism
Ventricular wall thickness is
Both ventricles are dilated
Impaired systolic function
-Enlargement of a portion of the myocardium; most commonly the left ventricle and the ventricular septum.
-Less room for ventricular filling = Decreased CO
-Enlargement of the intraventricular septum can obstruct of the aortic valve
Types of Cardiomyopathy:
Higher mortality rates are associated with
50% of patients with CHF die within 5 years
Signs and Symptoms
Paroxysmal nocturnal dyspnea
Dry cough at night
Narrow pulse pressure
S3 gallop rhythm
Signs of HF
Fluid volume overload
Signs and Symptoms
-Sudden death (especially in athletes)
-Migratory joint pain
Most rare subclass of cardiomyopathy
Associated with lack of flexibility of the ventricular walls.
Ventricles that restrict filling during diastole due to the physical inability to relax.
Poor prognosis, many patients die 1-2 years after diagnosis
Diseases in which the heart is intruded by foreign material or scarred.
• Collection of unwanted proteins (amyloidosis)
• Iron overload (hemochromatosis)
• Abnormal collection of inflammation growth tissue (sarcoidosis)
Most patients are asymptomatic until adulthood
• Heart block
Signs of right-sided CHF
Etiology and Risk factors
-The etiology is usually associated with genetic mutations
-Other causes are still unknown!
-The only real known risk factor is a genetic link.
-Children with a parent who has the condition are 50% more likely to inherit it.
-If a link exists, early testing is crutial
-Arrhythmia (a-fib, v-tach, and v-fib)
-Obstructed blood flow
-Mitral valve regurgitation
-Medication: Beta-blockers, CCB, antiarrhythmics
-Alcohol septal ablation
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Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C)
An inherited cardiomyopathy characterized by structural and functional abnormalities in the right ventricle (RV)
Important cause of sudden cardiac death (SCD) in young adults
Included in the World Health Organization’s classification of cardiomyopathies in 1996
More common in individuals of Greek and Italian origin
ARVD/C is an inherited disorder
Most common pattern of inheritance is autosomal dominance
Some evidence shows that ARVD/C may result from an infection within the heart muscle
Often caused by mutations in the desmosomes
Mechanical bonds that hold heart cells together are defective
Over time, the heart cells may pull apart, starting a process of scar and fat replacement
Signs and Symptoms
Sudden cardiac arrest
No single test that can either establish or exclude ARVD/C
Physical exam, family history, various cardiac tests, and genetic information are used as criteria
A 58 yr. old male with a history of HTN, CAD, and 2 yrs post MI presents to the ED with increasing fatigue, waking in the night with SOB, & inability to perform normal daily activities. He is a non-smoker, but drinks a 6-pack of beer nightly and currently takes lovastatin, and enalapril daily.
Heart & Lung sounds
Fluid status (edema, cap refill, JVD)
2-D echocardiogram w/doppler flow studies
Inotropic drugs (dobutamine)
ICD (implantable cardioverter/defibrillator)
CRT (cardiac resynchronization therapy)
Mitral valve replacement
Coronary artery bypass
Proper sleeping habits
Monitor activity levels
Reducing risk factors
Symptoms common to all types:
Shortness of breath
Signs and symptoms
Left Ventricular Assist Devices
Cardiac Resynchronization (Biventricular pacing)
Automatic Implantable Cardioverter- Defibrillators
Ventricular Restoration Surgery
Beta-blockers aid with bradycardia to allow ventricles to fill
calcium channel blockers
Ventricular & Supraventricular arrhythmias
Conduction system abnormalities
Cardiac stress test
Medications: Beta blockers and ACE-inhibitors
Implantable cardioverter defibrillators