Table Of Contents

Dilated Cardiomyopathy

Definition

• Dilation and impaired contraction of one or both ventricles (EF < 40%).

  

Etiology

• Ischemia
  • Focal areas of abnormal wall motion.
• Non-ischemic
  • Global hypokinesis.
• Infectious
  • Viral myocarditis, Chagas disease, Lyme disease.
• Systemic conditions
  • Hemochromatosis [late], sarcoidosis, thyrotoxicosis, wet beriberi
• Peripartum
  • Occurs in the last month of pregnancy or within five months postpartum.
• Toxic
  • Alcohol, chemotherapy (Doxorubicin)
• Familial/Genetic
  • Sarcomeric (Titin) protein mutations.
• Tachycardia-Mediated
  • Chronically rapid heart rate (untreated AF).

Clinical Presentation

• Systolic heart failure.

Diagnosis

• Transthoracic echocardiogram (TTE).

Management

• Same as HFrEF.

<aside> ❓

1️⃣ What is the mainstay of therapy to improve/normalize heart function in patients with alcoholic cardiomyopathy?

• Answer

2️⃣ What is the initial treatment for tachycardia-mediated cardiomyopathy?

• Answer </aside>

Restrictive Cardiomyopathy

Definition

• Process infiltrates myocardium, resulting in impaired ventricular diastolic relaxation.

  

Causes

• Infiltrative
  • Amyloidosis
  • Sarcoidosis
  • Hemochromatosis (Early in disease, later → DCM)
  • Fabry disease.
• Young Children
  • Endocardial fibroelastosis.
  • Loeffler's syndrome (endomyocardial fibrosis with prominent eosinophilic infiltrate).
    • Histology shows eosinophilic infiltrates in myocardium

Clinical Presentation

• Diastolic heart failure
• Prominent right heart symptoms.

Diagnosis

• TTE showing diastolic dysfunction with restrictive filling pattern, and bi-atrial enlargement.

Management

• Same as HFpEF.

Amyloid Cardiomyopathy - Thickened and restricted walls

Hypertrophic Cardiomyopathy

Watch ▶Hypertrophic cardiomyopathy: Clinical sciences

Definition

• Disorder of sarcomere proteins resulting in disorganized/hypertrophied myocytes.

  

Etiology

• Commonly autosomal dominant (AD) mutations in beta-myosin heavy chain or myosin binding protein C.

• Another Illustration

Clinical Presentation

• Heart failure (dyspnea), chest pain.
• Exertional syncope or sudden cardiac death.
  • Syncope in HOCM is multifactorial and can be due to outflow obstruction (interventricular septal hypertrophy), arrhythmia, ischemia, or a ventricular baroreceptor response that inappropriately causes vasodilation.
• Harsh systolic murmur (LLSB) and S4, (+/- mitral regurgitation).

Diagnosis