This power point presentation is about the myocardial diseases, among whom the cardiomyopathy is the commonest one.

1. Cardiomyopathy
Dr Javaria Aslam
Associate Professor Medicine
Medical Unit 1, NMU

2. • A 23-years old young male was playing football
in the playground of KEMU where he was
suddenly collapse and was brought to
emergency of Mayo Hospital. The boy was
started with ACLS protocol in the emergency.
• Unfortunately, He could not be reverted, and
was declared dead.
• 1 year later, his brother who was doing his house
job, started having exertional dyspnea, he was
diagnosed to have cardiomyopathy, shifted to US
for open heart surgery. He also was found dead
one day while he was doing an exertion

3.  Constitutes a group of diseases that
directly affect the structural or
functional ability of the myocardium

4. Classification
 Primary:
It refers to those conditions in which
the etiology of heart disease is unknown.
 Secondary:
It refers that the cause of myocardial
diseases are known.

5. 
World health organization classified into
 Dilated
 Hypertrophic
 Restrictive
CLASSIFICATION

6.  It is a condition in which the hearts
ability to pump blood OR to adjust the
incoming blood is decreased because the
left ventricle, is enlarged or weakened.
DEFINITION

8. Characterized by diffuse inflammation and
rapid degeneration of myocardial fibers
ventricular dilation
impairment of systolic function
Atrial enlargement and stasis of blood in the
left ventricle cardiomegaly
PATHOPHYSIOLOGY

9.  Cardiotoxic agents like alcohol or coccaine
 Genetic
 Hypertension
 Ischemia(CAD)
 Muscular dystrophy (Weakening and wasting
of muscles)
 Myocarditis
 Pregnancy
 Valve disease
ETIOLOGY

10.  Decreased exercise capacity
 Fatigue
 Dyspnea
 Paroxysmal nocturnal dyspnea
 Orthopnea
As the disease progresses,
 Dry cough, palpitations
 Abdominal bloating
 Nausea, vomiting
 anorexia
CLINICAL FEATURES

11.  Abnormal S3 and S4 sound
 Tachycardia or bradycardia
 Edema
 Pulmonary crackles
 Weak peripheral pulses
 Hepatomegaly
 Jugular venous distention

12.  History
 Echocardiography
 Chest x-ray: shows the signs of cardiomegaly
 ECG: reveals tachycardia, bradycardia and
dysarrythmias.
 Cardiac catheterization: it is performed to
confirm CAD
DIAGNOSTIC MEASURES

13.  Nitrates: eg- isosorbide dinitrate
 Loop diuretics: eg-furosemide
 ACE inhibitors: eg- captopril
 Beta adrenergic blockers: eg- atenolol
 Aldosterone antagonists: eg-
spironolactone
 Cardiac glycoside : eg-digoxin
 Anticoagulation therapy
MANAGEMENT

14.  Cardiac Transplantation
SURGICAL MANAGEMENT

15.  Assymetric left ventricular hypertrophy
without ventricular dilation.
 When the septum between two ventricles
become enlarged and obstructs the
blood flow from left ventricle, it is
known as hypertrophic obstructive
cardiomyopathy.
HYPERTROPHY CARDIOMYOPATHY

18.  Aortic stenosis
 Genetic
 Hypertension
 More common in men between ages 30 to
40
ETIOLOGY

19. Thickened intra-ventricular septum and
ventricular wall
ventricular hypertrophy
diastolic
dysfunction
impaired ventricular filling and obstruction to
decreased outflow
PATHOPHYSIOLOGY

20.  Exertional dyspnea (Shortness of breath
during exercise)
 Decreased cardiac output
 Fatigue
 Angina
 Syncope
 Hypertension

21.  History and physical examination
 Transthoracic echocardiogram.
 ECG
 Cardiac Catheterization
DIAGNOSIS

22.  Cardiac MRI. A cardiac MRI uses magnetic fields
and radio waves to create images of your heart.
Cardiac MRI is often used in addition to
echocardiography in the evaluation of people
with hypertrophic cardiomyopathy.

23.  Beta adrenergic blockers: eg- atenolol
 Calcium channel blocker: eg- verapamil
 Antidysrhythmic drugs : eg- amiodarone
MANAGEMENT

24.  Septal myectomy:
It is an open heart surgical procedure
in which the surgeon removes the part
of thickened , over grown septum
between the ventricles.
SURGICAL MANAGEMENT

25.  Septal ablation:
In this procedure a small portion of the
thickened heart muscle is destroyed by
injecting alcohol through a long, thin
tube into the artery supplying blood to
that area.

26.  Implantable cardioverter-defibrillator(ICD):
 It is recommended when the persons have life
threatening heart rhythm disorders. It is a small
instrument which can be implanted in the chest
as a pacemaker

27. 
• Disease of the heart muscle that impairs
diastolic filling and stretch and the systolic
function remains unaffected.
RESTRICTIVE CARDIOMYOPATHY

29.  Unknown etiology
 Myocardial fibrosis,
 Endocardial fibrosis,
 Sarcoidosis and
 Radiation to the thorax
ETIOLOGY

30. etiologic factors
Stiffness of the ventricular wall with loss of
ventricular compliance
Ventricles become resistant to filling
decrease cardiac output
PATHOPHYSIOLOGY

31.  Fatigue
 Exercise intolerance
 Dyspnea
 Orthopnea(shortness of breath (dyspnea) which occurs when
lying flat)
 Syncope
 Palpitations
 Peripheral edema
 Jugular venous distention
CLINICAL MANIFESTATIONS

32.  Chest x-ray: shows cardiomegaly
 ECG: shows tachycardia
 Echocardiography : for the visualization of
left ventricle
 CT-Scan and MRI Scan
INVESTIGATIONS

33.  MANAGEMENT
 Beta adrenergic blockers: eg- atenolol
 Calcium channel blocker: eg- verapamil
 Steriods: hydrocortisone
 Antidysrhythmic drugs : eg- amiodarone

34.  A heart transplantation may be
considered if the heart function is
very poor and the symptoms are
severe.

35.  Instruct the patient to take all medicines on
prescribed time.
 Encourage to use low sodium diet
 Instruct to drink more water
 Instruct the patient to maintain proper body
weight
 Teach the patient to balance activity and
rest
 Instruct the patient to avoid vigorous
activities and exercises
MANAGEMENT

36.  Encourage to perform stress reduction
activities.
 Teach about breathing and coughing
exercise
 Suggest the family members to learn about
CPR.

37. • A 25 years old lady presented in emergency
with worsening dyspnea for 3 weeks. He had
delivered to a baby almost 2 months ago. On
examination she had bilateral basal fine
inspiratory crackles. The JVP was raised and
there was also mild pedal edema.

41. Peripartum Cardiomyopathy
Management?