Cardiomyopathy Flashcards
What is the definition of cardiomyopathy?
Primary disease of the myocardium. Cardiomyopathy may be:
- Dilated
- Hypertrophic
- Restrictive
What is the aetiology of cardiomyopathy?
The majority are IDIOPATHIC
Dilated Cardiomyopathy
- Post-viral myocarditis
- Alcohol
- Drugs (e.g. doxorubicin, cocaine)
- Familial
- Thyrotoxicosis
- Haemochromatosis
- Peripartum
Hypertrophic Cardiomyopathy -
Up to 50% are genetic
Restrictive Cardiomyopathy
- Amyloidosis
- Sarcoidosis
- Haemochromatosis
What is the epidemiology of cardiomyopathy?
Prevalence of dilated and hypertrophic cardiomyopathy is 0.05-0.20%
Restrictive is even rarer
What are the presenting symptoms of dilated cardiomyopathy?
Dilated
- Symptoms of heart failure
- Arrhythmias
- Thromboembolism
- Family history of sudden death
What are the presenting symptoms of hypertrophic cardiomyopathy?
Hypertrophic
- Usually NO SYMPTOMS
- Syncope
- Angina
- Arrhythmias
- Family history of sudden death
What are the presenting symptoms of restrictive cardiomyopathy?
Restrictive
- Dyspnoea
- Fatigue
- Arrhythmias
- Ankle or abdominal swelling
- Family history of sudden death
What are the signs of dilated cardiomyopathy upon physical examination?
Dilated
- Raised JVP
- Displaced apex beat
- Functional mitral and tricuspid regurgitations
- Third heart sound
What are the signs of hypertrophic cardiomyopathy upon physical examination?
Hypertrophic
- Jerky carotid pulse
- Double apex beat
- Ejection systolic murmur
What are the signs of restritctive cardiomyopathy upon physical examination?
Restrictive
- Raised JVP => Kussmaul Sign - paradoxical rise in JVP on inspiration due to restricted filling of the ventricles
- Palpable apex beat
- Third heart sound
- Ascites
- Ankle oedema
- Hepatomegaly
What are the appropriate investigations for suspecting cardiomyopathy?
CXR
- May show cardiomegaly
- May show signs of heart failure
ECG
a) All Types
- Non-specific ST changes
- Conduction defects
- Arrhythmias
b) Hypertrophic
- Left-axis deviation
- Signs of left ventricular hypertrophy
- Q waves in inferior and lateral leads
c) Restrictive
- Low voltage complexes
Echocardiography
a) Dilated
- Dilated ventricles with global hypokinesia
b) Hypertrophic
- Ventricular hypertrophy (asymmetrical septal hypertrophy)
c) Restrictive
- Non-dilated non-hypertrophied ventricles
- Atrial enlargement
- Preserved systolic function
- Diastolic dysfunction
- Granular or sparkling appearance of myocardium in amyloidosis
Cardiac Catheterisation
Endomyocardial Biopsy
Pedigree or Genetic Analysis
