Cardiomyopathy

1. CardiomyopathyCardiomyopathy

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
The 3 main types of cardiomyopathy are:
u Dilated cardiomyopathy
u Hypertrophic cardiomyopathy
u Restrictive cardiomyopathy
CardiomyopathyCardiomyopathy

4. Dilated CardiomyopathyDilated Cardiomyopathy
u most common form of cardiomyopathy
u generally occurs in adults aged 20 to 60 years
u more common in men
 the heart muscle begins to dilate or stretch and become thinner

 Ventricular chamber size

over time, the heart becomes weaker  heart failure
 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
 a common reason for needing a heart transplant.

6. Types and Causes:Types and Causes:
uIschemic cardiomyopathy - caused by CAD & MI , w/c leave
scars in the heart muscle
uIdiopathic cardiomyopathy - the cause is unknown.
uHypertensive cardiomyopathy - seen in people who have high BP
for a long time, particuarly when it has gone untreated for years.
uInfectious cardiomyopathy - HIV, viral myocarditis
uAlcoholic cardiomyopathy - usually begins about 10 years after
sustained, heavy alcohol consumption.
uToxic cardiomyopathy – due to cocaine, amphetamines, and some
chemotherapy drugs (doxorubicin, daunorubicin)
uPeripartum cardiomyopathy: This type appears in women during
the last trimester of pregnancy or after childbirth.
u Radiotherapy (cobalt)
u diabetes and thyroid disease

7. Hypertrophic CardiomyopathyHypertrophic 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).
The right ventricle also may be affected.

9. Pathophysiology:
 Left ventricular hypertrophy (thick ventricular wall)  
ventricular chamber size  hold less blood   CO
  pressure in the ventricles and lungs
 changes in the cardiac muscles  interfere with the heart's
electrical signals, leading to arrhythmias  sudden cardiac arrest
Causes:
u inherited because of a gene mutation
u develop over time because of high blood pressure or aging
u often, the cause is unknown.
Hypertrophic CardiomyopathyHypertrophic Cardiomyopathy

11. Restrictive CardiomyopathyRestrictive Cardiomyopathy
u tends to mostly affect older adults
u the ventricles become stiff and rigid due to replacement of the
normal heart muscle with abnormal tissue, such as scar tissue.
u As a result, the ventricles cannot relax normally and expand to fill
with blood, which causes the atria to become enlarged.
u Eventually, blood flow in the heart is reduced, and complications
such as heart failure or arrhythmias occur.
Causes:
u radiation treatments, infections, or scarring after surgery
u Hemochromatosis - a condition in which too much iron is deposited
into tissues, including heart tissue
u Amyloidosis, a disease in which abnormal proteins are deposited into
heart tissue
u Sarcoidosis, a disease in which inflammation produces tiny lumps of
cells in various organs in the body, including the heart

12. Major Risk FactorsMajor Risk Factors
uHaving a family history of cardiomyopathy, heart failure, or sudden
cardiac death
uHaving a disease or condition that can lead to cardiomyopathy, such as:
uCoronary artery disease
uA previous heart attack
uMyocarditis
uDiseases that can damage the heart (for example, hemochromatosis,
sarcoidosis, or amyloidosis)
uLong-term alcoholism
uLong-term high blood pressure
uDiabetes and other metabolic diseases

13. Signs and SymptomsSigns and Symptoms
u some have no symptoms in the early stages of the disease
u as cardiomyopathy progresses and the heart weakens, signs and
symptoms of heart failure usually appear.
These signs and symptoms include:
uTiredness
uWeakness
uShortness of breath after exercise or even at rest
uSwelling of the abdomen, legs, ankles, and feet
uOther signs and symptoms: dizziness, lightheadedness, fainting during
exercise, abnormal heart rhythms, murmurs

14. InterventionsInterventions
The main goals of treating cardiomyopathy are to:
u Manage any conditions that cause or contribute to the
cardiomyopathy
u Control symptoms so that the person can live as normally as possible
u Stop the disease from getting worse
u Reduce complications and the chance of sudden cardiac death
Medications:
u Diuretics, which remove excess fluid and sodium from the body.
u Angiotensin-converting enzyme (ACE) inhibitors, which lower blood
pressure and reduce stress on the heart.
u Beta-blockers, which slow the heart rate by reducing the speed of
the heart's contractions. These medicines also lower BP
u Calcium channel blockers, which slow a rapid heartbeat by reducing
the force and rate of heart contractions, decrease BP

15. MedicationsMedications
u Digoxin - increases the force of heart contractions and slows the
heartbeat.
u Anticoagulants, which prevent blood clots from forming.
Anticoagulants are often used in the treatment of dilated
cardiomyopathy.
u Antiarrhythmia medicines, which keep the heart beating in a normal
rhythm.
u Antibiotics, which are used before dental or surgical procedures.
Antibiotics help to prevent endocarditis, an infection of the heart
walls, valves, and vessels.
u Corticosteroids, which reduce inflammation.

16. SurgerySurgery
u 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.
u 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.

17. Surgery (cont.)Surgery (cont.)
u 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.
u Heart Transplant

18. Left Ventricular Left Ventricular
Assist DeviceAssist Device
(LVAD)(LVAD)

20. Lifestyle ChangesLifestyle Changes
uThe doctor may recommend lifestyle changes to manage a condition
that is causing the cardiomyopathy. These changes may help reduce
symptoms. Lifestyle changes may include:
uQuitting smoking
uLosing excess weight
uEating a low-salt diet
uGetting moderate exercise, such as walking, and avoiding strenuous
exercise
uAvoiding the use of alcohol and illegal drugs
uGetting enough sleep and rest
uReducing stress
uTreating underlying conditions, such as diabetes and high blood
pressure

21. Heart TransplantHeart Transplant
u an operation in which the diseased heart in a person is replaced with
a healthy heart from a deceased donor.
u 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:
u 88 % of patients survive the first year after transplant
u 72 % survive for 5 years
u 50 % survive for 10 yrs.
u 16 % survive 20 years.

22. u Patients who might not be candidates for heart transplant
surgery, because the procedure is less likely to be successful.
u Advanced age - most transplant surgery isn't performed on
patients older than 70 years.
u Poor blood circulation throughout the body, including the brain.
u Diseases of the kidney, lungs, or liver that can't be reversed.
u History of cancer or malignant tumors.
u Inability or unwillingness to follow lifelong medical instructions
after a transplant.
u Pulmonary arterial hypertension (high blood pressure in the
lungs) that can't be reversed.
u Active infection throughout the body.
Heart Transplant (cont.)Heart Transplant (cont.)

23. u Organs are matched for blood type and size of donor and recipient.
u 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
Heart Transplant (cont.)Heart Transplant (cont.)

24. Heart Transplant (cont.)Heart Transplant (cont.)

25. u 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.
u Preventing Rejection
Immunosuppressants used: cyclosporine, tacrolimus, MMF
(mycophenolate mofetil), and steroids such as prednisone.
uWatching for Signs of Rejection
uShortness of breath
uFever
uFatigue
uWeight gain
uReduced amounts of urine
u Preventing Infection
Heart Transplant (cont.)Heart Transplant (cont.)

26. What Are the Risks of a Heart What Are the Risks of a Heart
Transplant? Transplant?
u Failure of the donor heart
uPrimary Graft Dysfunction
uRejection of the Donor Heart
uCardiac 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
u Complications from medicines - risk of infection, diabetes,
osteoporosis , high blood pressure, kidney damage, and cancer
u Infection
u Cancer – lymphoma and skin cancer (due to suppression of the
immune system)