{"id":9602,"date":"2021-12-28T00:50:15","date_gmt":"2021-12-27T22:50:15","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/debrecen-university\/cardiomyopathies\/"},"modified":"2021-12-28T17:15:34","modified_gmt":"2021-12-28T15:15:34","slug":"cardiomyopathies","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/cardiomyopathies\/","title":{"rendered":"Cardiomyopathies"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Cardiomyopathies describe a heterogeneous group of diseases affecting the myocardium.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Cardiomyopathy can be secondary to <strong>secondary <\/strong>to ischemic disease, hypertension, and valvular disease, or <strong>primary <\/strong>(intrinsic; will be discussed in this article).<\/p>\n\n\n<span class=\"block-heading\" id=\"header_1\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Classification<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<ul class=\"wp-block-list\"><li>Dilated cardiomyopathy<\/li><li>Hypertrophic cardiomyopathy<\/li><li>Restrictive cardiomyopathy<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Dilated cardiomyopathy<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<p class=\"wp-block-paragraph\">Dilated cardiomyopathy (DC) is characterized by progressive dilation and systolic dysfunction (the heart fails to pump properly).<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>The course is typically gradual, and the symptoms depend on the affected side.<ul><li>Right ventricular dysfunction appears with elevated venous pressure, prominent a wave in JVP, peripheral edema, hepatosplenomegaly.<\/li><\/ul><ul><li>Left ventricular dysfunction appears with reduced CO, dyspnea, fatigue, and syncope.<\/li><li>On both sides, intramural thrombosis and arrhythmias may occur.<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Etiology<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<ul class=\"wp-block-list\"><li><strong>Genetics<\/strong>. Mutations affecting cardiomyocyte proteins and (rarely) mitochondria.<\/li><li><strong>Infections<\/strong>. Myocarditis due to viral, bacterial, fungal, and parasitic infections. Coxackievirus is the most common in the developed world.<\/li><li><strong>Drugs and toxins<\/strong>. Alcohol, cobalt, chemotherapeutics.<\/li><li><strong>Metabolic disorders.<\/strong> Familial hemochromatosis, acromegaly, DM, beriberi (B1 deficiency)<\/li><li><strong>Granulomatous diseases<\/strong>. Sarcoidosis, granulomatosis with polyangiitis.<\/li><li><strong>Pregnancy<\/strong><\/li><li><strong>Prolonged tachycardia<\/strong><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<ul class=\"wp-block-list\"><li>Physical examination may demonstrate tachycardia<\/li><li>Cardiac enzymes are typically elevated<\/li><li>X-ray demonstrates cardiomegaly<\/li><li>ECG<\/li><li>MRI<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<ul class=\"wp-block-list\"><li>Treatment of the cause<\/li><li>Treatment of the heart failure<ul><li>Prognosis improving: ACEi\/ARBs, BB, aldosterone antagonists, ARNIs, SGLT2i<\/li><li>Quality of life improving: Diuretics, nitrates, CCB, ivabradin, digoxin<\/li><\/ul><\/li><li>Cardioverter-defibrilator, cardiac resynchronization therapy<\/li><li>Assisting devices (LVAD)<\/li><li>Transplantation<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Hypertrophic cardiomyopathy<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n\n<p class=\"wp-block-paragraph\">Hypertrophic cardiomyopathy (HCM) is characterized by substantial myocardial hypertrophy, defective cardiac filling (diastolic dysfunction), and in many cases, ventricular outflow obstruction.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Most cases are due to autosomal dominant mutations.<\/li><li>The intraventricular volume becomes progressively smaller, leading to increased ejection fraction.<\/li><li>Typically appears during young adulthood. HCM is a common cause of sudden cardiac death in young adults (athletes in particular).<\/li><li>Mitral regurgitation is frequently present.<\/li><li>Presents with with dyspnea on exertion, angina, and syncope. Arrhythmias are common.<\/li><li>Outflow obstruction appears in a majority of patients, worsened by increased contractibility (sympathetic stimulation, digoxin) and decreased ventricular filling (diuretics, nitrates, ACEi\/ARBs). Depending on the sevirity, may result in heart failure.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_7\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Etiology<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_7\">\n\n\n<p class=\"wp-block-paragraph\"><span style=\"font-size: revert; color: initial;\">HCM appears without volume or pressure overload.<\/span><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Most cases are due to autosomal dominant mutations of genes coding contractile proteins.<\/li><li>Other causes include acromegaly, pheochromocytoma, and neurofibromatosis.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_8\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_8\">\n\n\n<ul class=\"wp-block-list\"><li>Physical examination<ul><li><strong style=\"color: initial;\">Bisferiens carotid pulse<\/strong><span style=\"color: initial;\"> (two peaks per central pulse cycle)<\/span><\/li><\/ul><ul><li>Prominent a pulse in JVP in RV involvement<\/li><li>Systolic murmur, with increasing intensity with Valsalva maneuver, and decreased intensity when squatting<\/li><\/ul><\/li><li>ECG<\/li><li>Echocardiography<\/li><li>MRI<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_9\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_9\">\n\n\n<ul class=\"wp-block-list\"><li>Avoid straining<\/li><li>Beta-blockers<\/li><li>Negative inotropic drugs (disopyramide, which is also antiarrhythmic)<\/li><li>Nitrates, ACEi\/ARBs, diuretics, and digoxin are <strong style=\"color: initial;\">contraindicated <\/strong><span style=\"color: initial;\">(may worsen the obstruction)<\/span><\/li><li>Surgery (alcohol ablation, myectomy)<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_10\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Restrictive cardiomyopathy<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_10\">\n\n\n<p class=\"wp-block-paragraph\">Restrictive cardiomyopathy (RC) is characterized by stiffening of the heart, and diastolic dysfunction (the heart fails to relax).<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Least common form of cardiomyopathy. <\/li><li>The ejection fraction is preserved. <\/li><li>Pulmonary hypertension is commonly present, leading to right heart failure and reduced CO.<\/li><li>Presents with peripheral edema, hepatosplenomegaly, ascites, and symptoms related to reduced CO (dyspnea, angina, syncope). <\/li><li>Amyloidosis can appear with macroglossia, periorbital purpura, and hepatosplenomegaly.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_11\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Etiology<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_11\">\n\n\n<ul class=\"wp-block-list\"><li>Amyloidosis (most common)<\/li><li>Sarcoidosis<\/li><li>Scleroderma<\/li><li>Hemochromatosis<\/li><li>Endomyocardial fibrosis (seen in malnourished children)<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_12\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_12\">\n\n\n<ul class=\"wp-block-list\"><li>Echocardiography<\/li><li>MRI<\/li><li>Biopsy<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_13\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_13\">\n\n\n<ul class=\"wp-block-list\"><li>Treatment of the cause<\/li><li>Diuretics<\/li><\/ul>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Classification<\/h3><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Dilated cardiomyopathy<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Etiology<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Treatment<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Hypertrophic cardiomyopathy<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Etiology<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Treatment<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Restrictive cardiomyopathy<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Etiology<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Treatment<\/h4><\/div>","protected":false},"excerpt":{"rendered":"<p>Cardiomyopathies describe a heterogeneous group of diseases affecting the myocardium. Cardiomyopathy can be secondary to secondary to ischemic disease, hypertension, and valvular disease, or primary (intrinsic; will be discussed in this article). Classification Dilated cardiomyopathy Hypertrophic cardiomyopathy Restrictive cardiomyopathy Dilated cardiomyopathy Dilated cardiomyopathy (DC) is characterized by progressive dilation and systolic dysfunction (the heart fails [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":410,"menu_order":10,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-9602","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Cardiomyopathies &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/cardiomyopathies\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/cardiology\\\/cardiomyopathies\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/cardiology\\\/cardiomyopathies\\\/\",\"name\":\"Cardiomyopathies &#8211; 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