• S A 61-year-old male patient was admitted to hospital for dyspnea, chest pain, and
syncope that was not preceded by symptoms. The status of the patient had already
improved by the time the ambulance arrived.
• O taking history and physical examination.
• E aortic stenosis , fabry disease and cardiomyopathy restrictive.
• P Echo,ecg and holter monitor.
• E Β-blockers or surgical myectomy
• L cardiomyopathy
• CARDIOMYOPATHY (Literally "heart muscle disease") is the measurable
deterioration for any reason of the ability of the myocardium (the heart muscle)
to contract, usually leading to heart failure.
• Common symptoms include dyspnea (breathlessness) and peripheral edema
(swelling of the legs).
• The most common form of cardiomyopathy is dilated cardiomyopathy.
• Clinical classification of cardiomyopathies, hypertrophic,dilated and restrictive.
HYPERTROPHIC CARDIOMYOPATHY (HCM)
• An autosomal-dominant disorder of myocardial structural proteins that causes
premature, severe LVH.
DYSPNEA, CHEST PAIN AND SYNCOPE
1. The obstructive form presents with a systolic crescendo-decrescendo
murmur that intensifies with a reduction in left ventricular volume
(e.G., Standing, valsalva maneuver) and diminishes with an ↑ in left
ventricular volume (e.G., Hand grip or raising the legs when the patient
is in a supine position).
2. An s4 and a sustained apical impulse are characteristic.
echo, ecg and murmur
Treatment with negative inotropes such as β-blockers or verapamil is directed
toward improving diastolic filling in patients who are symptomatic. Avoid volume
depletion, avoid vasodilators, and start activity restriction.
Dilation and impaired contraction of one or both
• infectious (viral, chagas, hiv, lyme).
• toxic (alcohol, cocaine, methamphetamine, some
Exertional dyspnea, fatigue, syncope, ↓ exercise tolerance, and edema.
Exam reveals an elevated JVP, diffuse PMI, S3, S4, a holosystolic murmur of
mitral regurgitation, evidence of fluid overload (e.G., Crackles on lung exam,
lower extremity edema, ascites), and evidence of AF or other arrhythmias.
ecg, echo, lab and coronary angiography
Treatment is influenced by the development of heart failure.
Impaired diastolic filling with preserved systolic functioning.
• Infiltrative (amyloid, sarcoid).
• Noninfiltrative (familial, idiopathic).
• Storage (hemochromatosis, fabry).
• Endomyocardial fibrosis (endemic in certain areas of the world, radiation
Fatigue, and peripheral edema.
Exam reveals an elevated JVP that ↑ with inspiration (kussmaul’s sign) and a
normal left ventricular impulse; hepatosplenomegaly and ascites are seen in
ecg, acho and biopsy
Treatment aims to ↓ elevated filling pressures and treat symptoms of heart
failure. Diuretics may relieve symptoms; ccbs may improve diastolic relaxation.
Consider amiodarone or a defibrillator for high-risk patients with previous
dysrhythmias, LVH, syncope, or specific genetic mutations.