CARDIOMYOPATHY

BY: P.DHILIP KUMAR

DEFINITION
Cardiomyopathy constitutes a group of
disease that directly affect the structural and
functional ability of the myocardium
CLASSIFICATION
1. Dilated cardiomyopathy
2. Hypertrophic cardiomyopathy
3. Restrictive cardiomyopathy
TYPES OF CARDIOMYOPATHY
 Dilated cardiomyopathy:
It is characterized by a diffuse
inflammation and rapid degeneration of
myocardial fibers which results in ventricular
dilation and loss of systolic function.
ETIOLOGY
 Cardio toxic agents like alcohol, cocaine
doxorubicin
 Hypertension
 Ischemia
 Muscular disorders
 Myocarditis
 Genetic disorder
 Pregnancy and valve disease
PATHOPHYSIOLOGY
Due to any of the above causes

Inflammation to the myocardium

Degeneration of myocardial fibers

Ventricular dilation

Impaired systolic function

Atrial enlargement

Stasis of blood in the left ventricle

Contractile dysfunction
DIAGNOSTIC EVALUATION
 History collection related to alcoholism,
familial tendency
 P/E reveals dyspnea, tachycardia, weakness
 Echocardiogram to identify structural

abnormality
 Chest X- ray shows cardiomegaly
 ECG reveals dysarrythmias
 Nuclear imaging studies to identify ejection

fraction
 Cardiac catheterisation to rule out CAD.
CLINICAL MANIFESTATIONS
 Fatigue
 Weakness
 Palpitations Dyspnea
 Cardiomegaly
 Tachycardia
 Dysarrythmias
 Decreased cardiac output.
 Atrio ventricular valve impotence
MANAGEMENT
 Admn β- adrenergic blockers like metaprolol
And aldosterone
 Digoxin to treat fibrillation
 Anticoagulants like Heparin to prevent embolisation
 ACE inhibitors like captopril to reduce after load
 Antidysarrythmias like amiadarone to treat dysarrythmias.
 Low salt and low cholesterol diet
 Intermittent Dobutamine and milrinone infusions to treat

multiple episodes of heart failure.

 Provide complete bed rest
CONTD…
 Cardiac resynchronization therapy:
This co-ordinates with RT and LT
ventricle contractility through biventricular
pacing. This helps to have normal electrical
conduction with in the RT and LT ventricles
and increase LT ventricular function and
cardiac output.
SURGICAL MANAGEMENT
CARDIAC TRANSPLANTATION:
It is the procedure involving the transfer of
heart from one person to another.
HYPERTROPIC CARDIOMYOPATHY
 It is formerly called as idiopathic hypertrophic
sub aortic stenosis which is an asymmetric
left ventricular hypertrophy without
ventricular dilation.
CHERACTERISTIC
The main 4 characteristic of hypertrophic
cardiomyapathy are
1. Massive ventricular Hypertrophy
2. Rapid forceful contraction of the left
ventricle
3. Impaired relaxation
4. Obstruction of the aortic outflow.
ETIOLOGY
 Aortic stenosis
 Hypertension
 Genetic disorders
PATHOPHYSIOLOGY
Due to conditions like aortic stenosis

Obstruction to the outflow of blood from left ventricles

Impaired ejection of blood from LV to Aorta

Decreased cardiac out

Increased ventricular function

Multiplication of tissues

Hypertrophy of the myocardium

CLINICAL MANIFESTATIONS
 Dyspnea
 Fatigue Angina
 Syncope
 Palpitation
 Cardiomegaly
 Dysarrythmias
 Decreased cardiac output
DIAGNOSTIC EVALUATION
 History collection related to Hypertension and
familial tendency
 P/E reveals dyspnea, tachycardia, weakness

and syncope.
 Echocardiogram helps to reveal LT ventricular

Hypertrophy.
 Chest X- ray shows cardiomegaly
 ECG reveals dysarrythmias
 Cardiac catherization reveals decrease

chamber size.
MANAGEMENT
 Admn β-adrenergic blockers like metoprolol
 Calcium channel blockers like verapamil to

improve ventricular filling and relive LT

ventricular outflow obstruction
 Digitalis to treat atrial fibrillation
 Antidysarrythmias like amiadarone to treat

dysarrythmias.
 Low salt and low cholesterol diet
 TED stockings to prevent DVT.
 Contd…
 Implantable cardioverter defibrillator is used
to treat dysarrythmias.
 Atrio ventricular pacing is used for patients

hypertrophic cardiomyopathy to treat outflow

obstruction.
SURGICAL MANAGEMENT
 Myomectomy:
It involves the incision of the hypertrophied
septal muscle and removal of hypertrophied
ventricular muscles.
 Percutaneous transluminal septal myocardial
ablation:
This procedure involves administering
alcohol in to the first septal artery branching off
ant. descending artery which causes ischemia and
septal wall MI. Ablation of septal wall decrease
obstruction to flow the pt symptoms will decrease.
Restrictive Cardiomyopathy
It is a refers to the changes in weakening of the
heart muscle that impairs diastolic filling and
stretch.
 ETIOLOGY
 Amyloidosis
 Emdomyocardial fibrosis
 Neoplastic tumor
 Sarcoidosis
 Ventricular thrombus
 Scarring after radiation therapy and

chemotherapy
 PATHOPHYSIOLOGY
Due to any of the pathological processes

Fibrosis deposition on the myocardium

Myocardial hypertrophy

Stiffness of the ventricular wall

Loss of ventricular compliance

Ventricles are resistant to filling

 CLINICAL MANIFESTATIONS
 Dyspnea
 Fatigue
 Mild cardiomegaly
 Atrio ventricular incompetence
 Dysarrythmias
 Angina
 Orthopnea
 Syncope
 Palpitations
 Periperal edema
 Ascities
 Hepatomegaly
 Jugular venous distension
 DIAGNOSTIC EVALUATION
 Chest x-ray may be normal or mild cardiomegaly,
RT heart enlargement, pleural effusion and
pulmonary congestion
 ECG reveals tachycardia, atrial fibrillation, supra

ventricular dysarrythmias
 Echocardiogram shows thickened ventricular

walls and slight dilation in RT ventricle and

dilated atria.
 Endomyocardial biopsy to identify sarcoidosis,

Amyloidosis of myocardial tissue

 CT and nuclear imaging to confirm diagnosis.
 MANAGEMENT
 Administer prophylactic antibiotics like penicillin.
 Admn β-adrenergic blockers like metoprolol
 Calcium channel blockers like verapamil to

improve ventricular filling and relive LT

ventricular outflow obstruction
 Digitalis to treat atrial fibrillation
 Antidysarrythmias like amiadarone to treat

dysarrythmias.
 Low salt and low cholesterol diet
 TED stockings to prevent DVT.
 Contd…
 Administer diuretics to remove excess fluid.
 Administer anti coagulants like Heparin to

prevent clot formation.

 Implantable cardioverter defibrillator is used

to treat dysarrythmias.
 PATIENT AND FAMILY TEACHING
 Instruct patient to take all medicines as
prescribed and to follow with health care
provider.
 Encourage the Patient to use low sodium diet.
 Unless the fluid is restricted patients should be

encouraged to drink 6 to 8 glasses of water every

day
 Advise the patient to avoid alcohol, caffeine, diet

pills and over the counter drugs

 Advise the patient to take rest in between the

activities
 Contd…
 Instruct the patient to avoid lifting of heavy weights
and vigorous activities
 Encourage the use of stress reduction activities like
relaxation to relieve tension.
 Instruct the patient to report any signs of heart
failure like increased weight gain, edema, shortness
of breath and increased fatigue.
 Teach the family members on CPR because of sudden
cardiac arrest.
 Instruct the patient to notify the health care provided
before any dental and medical procedures to be done
as it risk for endocarditis.