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  1. 1. Cardiomyopathy Presented by Likhila abraham
  2. 2.  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
  3. 3. Definition Cardiomyopathy is a heart muscle disease of unknown cause (levis)
  4. 4. Cardiomyopathy is a measurable heart deterioration of the function of the myocardium leading to heart failure
  5. 5. 2006 AHA defined cardiomyopathies as “a heterogeneous group of diseases of the myocardium associated with mechanical &/or electrical dysfunction that usually (but not invariably) exhibit inappropriate ventricular hypertrophy or dilatation and are due to a variety of causes
  6. 6. Etiology Long term bp Diseases Infection Genetic Pregnancy HIV others
  7. 7. The 3 main types of cardiomyopathy are:  Dilated cardiomyopathy  Hypertrophic cardiomyopathy  Restrictive cardiomyopathy
  9. 9. Dilated Cardiomyopathy  most common form of cardiomyopathy  generally occurs in adults aged 20 to 60 years  more common in men  the heart muscle begins to dilate or stretch and become thinner   Ventricular chamber size  over time, the heart becomes weaker  symptoms of heart failure: fatigue, edema, and SOB  can also lead to heart valve problems (regurgitation), arrhythmias, and blood clots in the heart (poor blood flow), emboli formation  .
  10. 10. 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
  11. 11. Clinical features-  Highest incidence in middle age  Symptoms may be gradual in onset  Acute presentation  Misdiagnosed as viral URI in young adults  Symptoms/Signs of heart failure  Pulmonary congestion (left heart failure) dyspnea (rest, exertional, nocturnal), orthopnea  Systemic congestion (right heart failure) edema, nausea, abdominal pain, nocturia  Low cardiac output  Hypotension, tachycardia, tachypnea  Fatigue and weakness  Arrhythmia  Atrial fibrillation, conduction delays,,sudden death
  12. 12. Hypertrophic cardiomyopathy  Characterised by myocardial hypertrophy,abnormal diastolic filling,intermittent ventricular outflow obstruction  Related to defects in force generation owing to altered sarcomeric function  Leading cause of LVH,unexplained by other clinical/pathologic cause  Caused by mutation of genes encoding sarcomeric proteins
  13. 13. Hypertrophic Cardiomyopathy  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).
  14. 14. Restrictive 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
  15. 15. Signs 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
  16. 16. 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.
  17. 17. 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.
  18. 18. 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
  19. 19. 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
  20. 20. 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.
  21. 21. 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.
  22. 22. 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
  23. 23. Heart Transplant (cont.)
  24. 24. 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
  25. 25. 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)