Cardiomyopathy - Internal Medicine .pptx

Understanding Cardiomyopathy

Cardiomyopathy encompasses a group of myocardial diseases characterized by structural changes in the heart muscles, leading to impaired function. Three main types exist:

Dilated Cardiomyopathy (DCM)
Enlarged heart chambers
Reduced contractility
Common symptoms: fatigue, dyspnea, chest pain
Hypertrophic Cardiomyopathy (HCM)
Thickened heart muscle
Impaired diastolic filling
Often genetic; may cause sudden cardiac death
Restrictive Cardiomyopathy (RCM)
Stiffened myocardium
Limited ventricular filling
Associated with infiltrative diseases
Diagnostic Approach:

ECG: Detect arrhythmias and conduction abnormalities.
Echocardiography: Assess chamber size, wall thickness, and ejection fraction.
Cardiac MRI: Detailed imaging of myocardium.
Treatment Strategies:

Medications (ACE inhibitors, beta-blockers)
Lifestyle modifications (salt restriction, alcohol cessation)
Advanced cases may require heart transplantation.
In summary, early diagnosis, tailored management, and patient education are crucial in addressing cardiomyopathy.

1. 3.4

2. SOEPE Subjective 24-year-old woman Objective decreasing exercise tolerance (NYHA fc III). A few months ago, she had a fever and cough AB didn’t work Symptoms are on and off with treatment Evaluation PE: bilateral basal crepitations ECG showed a sinus rhythm with a frequency of 100/min and diffuse abnormalities of the T-waves. Lung X-rays showed an enlarged heart and pulmonary congestion Echo: dilated LV and LA (EF<20%) Plan obtain echocardiogram H/O of cardiac examination Elaboration: DDx Cardiomyopathy Myocarditis Pericarditis Rheumatic Heart disease. Beriberi (Thiamine Deficiency )

3. DDx : Cardiomyopathy Myocarditis Pericarditis Rheumatic Heart disease.

4. Definition In 1995, myocarditis was defined by the World Health Organization (WHO)/International Society and Federation of Cardiology (ISFC) as an inflammatory disease of the heart muscle, diagnosed by established histological, immunological, and immunohistochemical criteria

5. Definition Dilated cardiomyopathy is a progressive disease of heart muscle that is characterized by ventricular chamber enlargement and contractile dysfunction. Dilated cardiomyopathy is the third most common cause of heart failure and the most frequent reason for heart transplantation.

6. Heart failure when the heart is unable to pump blood forward at a sufficient rate to meet the metabolic demands o the body or is able to do so only if cardiac filling pressures are abnormally high.

7. Dilated Cardiomyopathy Hypertrophic Obstructive Cardiomyopathy

8. Diagnosis of DCM Clinical Findings: decreased tissue perfusion: fatigue, light-headedness, and exertional dyspnea. Pulmonary congestion : dyspnea, orthopnea, and paroxysmal nocturnal dyspnea chronic systemic venous congestion: ascites , peripheral edema. ( these symptoms may develop insidiously, the patient may complain only of recent weight gain (because of interstitial edema) and shortness of breath on exertion.) Physical Examination: Signs of decreased cardiac output : cool extremities, low arterial pressure. Pulmonary venous congestion: auscultatory rales (crackles), basilar chest dullness to percussion. Cardiac examination: enlarged heart with leftward displacement of the apical impulse. On auscultation; third heart sound (S3) (sign of poor systolic function) The murmur of mitral valve regurgitation is a result of left ventricular dilatation.

9. ECG chest radiograph shows an enlarged cardiac silhouette/ pulmonary edema Echocardiography globally dilated hypokinetic heart and low ejection fraction. With/without mitral and tricuspid valve regurgitation Blood : Elevated Biomarkers BNP (ventricular stretching) ANP (atrial stretching) Cardiac catheterization or CT angiography is perormed to determine whether coexistent coronary artery disease is contributing to the impaired ventricular unction Cardiac magnetic resonance imaging (MRI) ; is sueful to assess contributory myocardial in fl ammation (myocarditis).

10. Laboratory Investigations to confirm Dilated Cardiomyopathy (Heart Failure in General)

11. ECG

12. Cardiac magnetic resonance imaging (CMR)

13. Echocardiography

14. Treatment Acutely: Inotropic > Milrinone   Extremely > ventilation

15. The goal of therapy in DCM is to promote reverse remodeling of dilated ventricles, enhance myocardial f unction, relieve symptoms, prevent complication. β-blockers ( metoprolol succinate, carvedilol , and bisoprolol ) ACE inhibitors or ARBs decreases both the preload and afterload and prevents heart remodeling Diuretics ( Spironolactone  ) decrease the fluid retention Digitalis the only non- proarrhythmic inotrope (Increases heart contractility) Aspirin in cases of suspected atrial fibrillation medical MANAGMENT

16. Biventricular pacemakers , which use electrical impulses to coordinate the actions of the left and right ventricles. Implantable cardioverter-defibrillators (ICDs ), which monitor heart rhythm and deliver electrical shocks when needed to control abnormal, rapid heartbeats, including those that cause the heart to stop. They can also function as pacemakers. Left ventricular assist devices (LVADs ) , which are mechanical devices implanted into the abdomen or chest and attached to a weakened heart to help it pump. They usually are considered after less invasive approaches are unsuccessful. Heart transplant

17. guidelines from the ACC/AHA (1) evaluation of LV systolic function before arrival during hospitalization (2) administration of an ACE inhibitor or ARB’s (3) discharge instructions given to patient or caregiver addressing all of the following: activity level, diet, discharge medications, , weight monitoring, and what to do if symptoms worsen (4) adult smoking cessation advice or counseling (5) anticoagulation therapy for eligible patients with atrial fibrillation.

18. : Thanks !