Your SlideShare is downloading. ×
0
Cardiomyopathy A group of diseases that primarily affects the heart muscle and are not the result of congenital, acquired ...
We are going to cover… <ul><li>1. dilated cardiomyopathy (DCM) </li></ul><ul><li>2. hypertrophic cardiomyopathy (HCM) </li...
Fundamental form of cardiomyopathy <ul><li>1. Primary type-heart muscle disease predominantly involving the myocardium and...
Classification
Diagramatic representation of different cardiomyopathies
Dilated cardiomyopathy <ul><li>Is a disease of heart muscle characterised by </li></ul><ul><ul><li>dilation of the cardiac...
Pathophysiology  <ul><li>May be secondary to progression of any process that affects myocardium </li></ul><ul><li>Dilation...
 
Diagnosis  <ul><li>Clinical presentation </li></ul><ul><ul><li>Symptomatic HF (syncope, dyspnea, volume overload)  </li></...
<ul><li>Diagnostic testing </li></ul><ul><ul><li>Confirm with echocardiography/radionuclide venticulography. </li></ul></u...
Radionuclide venticulography Red area indicates blood column. Blue area indicates myocardial perfusion
Treatment  <ul><li>Therapeutic strategy include control of total body sodium and volume in addition to appropriate preload...
Hypertrophic CM <ul><li>Most common cause of sudden death in young athletes. </li></ul><ul><li>Prevalence approx. 100 per ...
<ul><li>Heart failure may develop because stiff non-compliant ventricles impede systolic filling. </li></ul><ul><li>Septal...
 
Pathophysiology  <ul><li>Condition is genetic disorder with Autosomal Dominant transmission. </li></ul><ul><li>Due to sing...
Symptoms & Signs <ul><li>Symptoms </li></ul><ul><ul><li>Angina on effort </li></ul></ul><ul><ul><li>Dyspnea on effort </li...
Treatment <ul><li>B-blocker and rate-limiting calcium antagonists (eg verapamil) </li></ul><ul><li>No pharmacological trea...
 
Restrictive CM <ul><li>Rare condition </li></ul><ul><li>Ventricular filling is impaired because ventricles are stiff. </li...
 
Investigation <ul><li>Diagnosis is difficult </li></ul><ul><li>Require complex Doppler echocardiography </li></ul><ul><li>...
Treatment  <ul><li>Symptomatic </li></ul><ul><li>Usually prognosis is poor </li></ul><ul><li>Transplantation is the best t...
Arrhythmogenic Right Ventricular Dysplasia <ul><li>In this condition, patches of the right ventricular myocardium are repl...
 
Obliterative Cardiomyopathy <ul><li>It is also rare in India. </li></ul><ul><li>Involves the endocardium of one or both ve...
<ul><li>Associated with eosinophilia </li></ul><ul><ul><li>Eg: eosinophilic leukemia, churg strauss syndrome </li></ul></u...
 
Upcoming SlideShare
Loading in...5
×

Cardiomyopathy for undergraduates

1,053

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
1,053
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
109
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Transcript of "Cardiomyopathy for undergraduates"

  1. 1. Cardiomyopathy A group of diseases that primarily affects the heart muscle and are not the result of congenital, acquired valvular, hypertensive, coronary arterial and pericardial abnormalities. Prepared by: Fadziyah Zaira Bte Md Fadzil 4 th Year, GEF International Medical School, Bangalore, India
  2. 2. We are going to cover… <ul><li>1. dilated cardiomyopathy (DCM) </li></ul><ul><li>2. hypertrophic cardiomyopathy (HCM) </li></ul><ul><li>3. restrictive cardiomyopathy (RCM) </li></ul><ul><li>4. arrhythmogenic right ventricular dysplasia (ARVD) </li></ul><ul><li>5. obliterative cardiomyopathy (OCM) </li></ul>
  3. 3. Fundamental form of cardiomyopathy <ul><li>1. Primary type-heart muscle disease predominantly involving the myocardium and of unknown etiology. </li></ul><ul><li>2. Secondary type- myocardial disease of known cause/ associated with a systemic disease. Eg: amyloidosis, chronic alcoholic use. </li></ul>
  4. 4. Classification
  5. 5. Diagramatic representation of different cardiomyopathies
  6. 6. Dilated cardiomyopathy <ul><li>Is a disease of heart muscle characterised by </li></ul><ul><ul><li>dilation of the cardiac chambers </li></ul></ul><ul><ul><li>Reduction in ventricular contractile function </li></ul></ul><ul><li>Epidemiology </li></ul><ul><ul><li>The most common form of CM </li></ul></ul><ul><ul><li>Responsible for 10,000 death and 46,000 hospitalizations per year. </li></ul></ul>
  7. 7. Pathophysiology <ul><li>May be secondary to progression of any process that affects myocardium </li></ul><ul><li>Dilation is directly related to neurohormonal activation </li></ul><ul><li>Associated with atrial and ventricular arrhythmia in 1 ½ patients (probably responsible for the high incidence of sudden death in the population) </li></ul><ul><li>Results in Tricuspid and Mitral regurgitation due to the effect of chamber dilatation on the valvular apparatus. </li></ul>
  8. 9. Diagnosis <ul><li>Clinical presentation </li></ul><ul><ul><li>Symptomatic HF (syncope, dyspnea, volume overload) </li></ul></ul><ul><ul><li>Some patients are asymptomatic </li></ul></ul><ul><ul><li>ECG shows nonspecific changes </li></ul></ul><ul><ul><ul><li>Sinus tachy/atrial fibrillation </li></ul></ul></ul><ul><ul><ul><li>Ventricular arrhythmias </li></ul></ul></ul><ul><ul><ul><li>Left atrial abnormality </li></ul></ul></ul><ul><li>Physical exam </li></ul><ul><ul><li>Variable degrees of cardiac enlargement </li></ul></ul><ul><ul><li>Pulse pressure is narrow </li></ul></ul><ul><ul><li>JVP raised </li></ul></ul><ul><ul><li>3 rd or 4 th heart sound are common </li></ul></ul><ul><ul><li>Mitral/ tricuspid regurgitation may occur </li></ul></ul>
  9. 10. <ul><li>Diagnostic testing </li></ul><ul><ul><li>Confirm with echocardiography/radionuclide venticulography. </li></ul></ul><ul><ul><li>CTI and CMRI can also be done. </li></ul></ul><ul><ul><li>2D and Doppler Echo is helpful to differentiate from other CM </li></ul></ul><ul><ul><li>Angiography reveals dilated, hypokinetic LV with some degree of mitral regurgitation. </li></ul></ul><ul><ul><li>* In India, the most common diagnostic test used for DCM is 2D echocardiography. </li></ul></ul>
  10. 11. Radionuclide venticulography Red area indicates blood column. Blue area indicates myocardial perfusion
  11. 12. Treatment <ul><li>Therapeutic strategy include control of total body sodium and volume in addition to appropriate preload and afterload reduction using vasodilator therapy. </li></ul><ul><li>B-blocker should be used unless CI </li></ul><ul><li>Angiotensin receptor antagonist </li></ul><ul><li>Cardiac transplantation is the treatment of choice. </li></ul>
  12. 13. Hypertrophic CM <ul><li>Most common cause of sudden death in young athletes. </li></ul><ul><li>Prevalence approx. 100 per 1 lakh population </li></ul><ul><li>Characterized by in appropriate and elaborate LV hypertrophy with misalignment of the myocardial fibres. </li></ul><ul><li>Hypertrophy may be generalized or confined largely to interventricular septum. </li></ul>
  13. 14. <ul><li>Heart failure may develop because stiff non-compliant ventricles impede systolic filling. </li></ul><ul><li>Septal hypertrophy may cause dynamic LV outflow obstruction. </li></ul><ul><li>Mitral regurgitation occur due to abnormal systolic anterior mitral valve leaflet. </li></ul>
  14. 16. Pathophysiology <ul><li>Condition is genetic disorder with Autosomal Dominant transmission. </li></ul><ul><li>Due to single point mutation in one of the genes that encode sarcomeric contractile proteins. </li></ul>
  15. 17. Symptoms & Signs <ul><li>Symptoms </li></ul><ul><ul><li>Angina on effort </li></ul></ul><ul><ul><li>Dyspnea on effort </li></ul></ul><ul><ul><li>Syncope on effort </li></ul></ul><ul><ul><li>Sudden death </li></ul></ul><ul><li>Signs </li></ul><ul><ul><li>Jerky pulse </li></ul></ul><ul><ul><li>Palpable LV heave </li></ul></ul><ul><ul><li>Double impulse at apex </li></ul></ul><ul><ul><li>mid-systolic murmur –sign of LV outflow obstruction </li></ul></ul><ul><ul><li>Pansystolic murmur </li></ul></ul>
  16. 18. Treatment <ul><li>B-blocker and rate-limiting calcium antagonists (eg verapamil) </li></ul><ul><li>No pharmacological treatment is known to improve prognosis </li></ul><ul><li>Arrhythmia is common and responds well to amiodarone. </li></ul><ul><li>Outflow tract obstruction can be improved by </li></ul><ul><ul><li>partial surgical resection (myectomy) or </li></ul></ul><ul><ul><li>iatrogenic infarction of basal septum (septal ablation) </li></ul></ul><ul><li>Implantable cardiac defibrillation (ICD) for patient with risk of sudden death. </li></ul>
  17. 20. Restrictive CM <ul><li>Rare condition </li></ul><ul><li>Ventricular filling is impaired because ventricles are stiff. </li></ul><ul><li>Lead to high atrial pressure with atrial hypertrophy, dilatation and later atrial fibrillation. </li></ul><ul><li>Amyloidosis is the most common cause. </li></ul><ul><li>Other form: </li></ul><ul><ul><li>Idiopathic perimyocyte fibrosis </li></ul></ul><ul><ul><li>Familial restrictive cardiomyopathy </li></ul></ul>
  18. 22. Investigation <ul><li>Diagnosis is difficult </li></ul><ul><li>Require complex Doppler echocardiography </li></ul><ul><li>CT and MRI and endomyocardial biopsy may be done. </li></ul>
  19. 23. Treatment <ul><li>Symptomatic </li></ul><ul><li>Usually prognosis is poor </li></ul><ul><li>Transplantation is the best treatment. </li></ul>
  20. 24. Arrhythmogenic Right Ventricular Dysplasia <ul><li>In this condition, patches of the right ventricular myocardium are replaced with fibrous and fatty tissue. </li></ul><ul><li>Inherited as autosomal dominant trait </li></ul><ul><li>Prevalence in UK 10 per 1 lakh population. </li></ul><ul><li>Dominant clinical problems are </li></ul><ul><ul><li>ventricular arrhythmia </li></ul></ul><ul><ul><li>Sudden death </li></ul></ul><ul><ul><li>Right sided cardiac failure </li></ul></ul><ul><li>ECG shows inverted T waves in the right precordial leads. </li></ul><ul><li>MRI useful diagnostic tool and used to screen 1 st degree relatives from having the same pathology. </li></ul>
  21. 26. Obliterative Cardiomyopathy <ul><li>It is also rare in India. </li></ul><ul><li>Involves the endocardium of one or both ventricles and is characterized by thrombosis and elaborate fibrosis with gradual obliteration of the ventricular cavities. </li></ul><ul><li>Mitral and tricuspid valves are regurgitant. </li></ul><ul><li>Heart failure and pulmonary and systemic embolism are prominent. </li></ul>
  22. 27. <ul><li>Associated with eosinophilia </li></ul><ul><ul><li>Eg: eosinophilic leukemia, churg strauss syndrome </li></ul></ul><ul><li>Mortality is high (50% at 2 years of developing the symptoms) </li></ul><ul><li>Anticoagulation and antiplatelet therapy is advisable and diuretics may help symptoms of HF. </li></ul><ul><li>Surgery valve replacement with decortication of endocardium may be helpful in certain cases. </li></ul>
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×