Cardiomyopathy is a progressive disorder that alters the structure or impair the functioning of the muscular wall of the heart’s lower chambers (ventricles).
Cardiomyopathy can be caused by many diseases known or may be due to unidentified causes.
Dilated congestive cardiomyopathy
Congestive dilated cardiomyopathy is a group of cardiac disorders in which the ventricles are enlarged, but are not able to pump enough blood to the body’s needs and consequently heart failure occurs.
In developed countries, the most common identifiable cause of dilated congestive cardiomyopathy is widespread coronary artery disease. The disease causes an inadequate blood supply to the heart muscle, which can lead to permanent injury. The non-injured heart muscle is stretched to compensate for the loss of pumping action. When this stretch can not adequately compensate for the deficit, there is dilated congestive cardiomyopathy.
An acute inflammation of the heart muscle (myocarditis) caused by a viral infection, can weaken and cause dilated congestive cardiomyopathy (sometimes called viral cardiomyopathy). Infection with Coxsackie B virus is the most common cause of viral cardiomyopathy. Certain chronic hormonal disorders such as diabetes and thyroid disease can also cause dilated congestive cardiomyopathy, and the consumption of certain drugs (like alcohol and cocaine) and drugs (like antidepressants). Alcoholic cardiomyopathy occurs after about 10 years of alcohol abuse. In rare cases, pregnancy or certain connective tissue diseases such as rheumatoid arthritis, can cause dilated congestive cardiomyopathy.
Symptoms and Diagnosis
The initial symptoms of dilated congestive cardiomyopathy (feeling breathlessness during physical exertion and tiring easily) are the result of weakened pumping action of the heart (heart failure). When the cause of cardiomyopathy is an infection, the first symptoms can be sudden fever and similar to the flu. In any case, the heart rate quickens, blood pressure is normal or low, there is fluid retention in legs and abdomen and the lungs fill with fluid.
The enlarged heart makes the heart valves open and close improperly, in the case of tricuspid and mitral valve, there is an abnormal reflux of blood from the ventricles into the atria during systole, in view of not close properly. Improper closure of the valves cause murmurs can be heard with a stethoscope. Finally, injury and stretching of the heart muscle produce abnormally rapid heart rate or slow. These anomalies further alter the heart’s pumping function.
The diagnosis is based on symptoms and physical examination. The electrocardiogram (a test that records the heart’s electrical activity) shows characteristic changes. The echocardiogram (a test that uses sound waves to create an image of cardiac structures) and magnetic resonance imaging (MRI) confirmed the diagnosis. If, despite these procedures, the diagnosis is still uncertain, a more accurate assessment requires a catheter to measure pressures within the heart. During the catheterization, you can extract a sample of tissue for microscopic analysis (biopsy) and thus confirm the diagnosis and often even hear the case.
Prognosis and Treatment
About 70 percent of people with dilated congestive cardiomyopathy die within 5 years of onset of first symptoms, prognosis worsens as the heart’s walls become thinner and heart function declines. Abnormalities in heart rate also indicate a poor prognosis.
According to studies, both sex and ethnic origin play an important role in prognosis. Overall, only half survive men compared with women and people of black ethnicity half compared with those of white ethnicity. About 50 percent of deaths are sudden, probably as a result of cardiac arrhythmia.
Specifically address the underlying cause such as alcohol abuse or infection can prolong life. If the cause is the abuse of alcohol, it is necessary to abstain from alcohol. Antibiotic treatment is indicated if a bacterial infection that produces the sudden inflammation of the heart muscle.
If a person with coronary artery disease, poor blood supply for heart failure can cause angina (chest pain from heart disease), which requires the application of a treatment with nitrates, a beta-blocker or a blocker calcium channel.
Beta-blockers and blockers of calcium channels can reduce the strength of heart contractions. Sufficient rest, adequate sleep and stress reduction help reduce the strain on the heart.
The stagnation of blood in enlarged heart can cause blood clots in the walls of the cavities. To prevent this coagulation, anticoagulant drugs are usually administered.
In general, drugs used to prevent arrhythmias are prescribed in small doses, then increase gradually, as they may reduce the strength of heart contractions. Heart failure is also treated with drugs (an inhibitor of angiotensin converting enzyme, which is often associated with a diuretic).
However, unless the specific cause of dilated congestive cardiomyopathy can be treated, it is likely that heart failure is ultimately fatal. Given this poor prognosis, those with dilated congestive cardiomyopathy are the leading candidates for a heart transplant.
Hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy is a group of heart disorders characterized by ventricular hypertrophy (a thickening of the walls of the ventricles).
Hypertrophic cardiomyopathy is hereditary in certain cases. You can also occur in patients with acromegaly, a disease resulting from the presence of excessive amounts of growth hormone in the blood or in those with pheochromocytoma, a tumor that produces adrenalin. People with neurofibromatosis, a hereditary disease, can also develop hypertrophic cardiomyopathy.
Usually, a thickening of the muscular walls of the heart muscle represents a reaction against an increase in cardiac workload. The most common causes are high blood pressure, narrowing of the aortic valve (aortic valve stenosis) and other disorders that increase the output resistance to blood from the heart. However, patients with hypertrophic cardiomyopathy do not have these conditions. In contrast, the thickening that occurs in this disease is usually due to an inherited genetic abnormality.
The heart thickens and becomes stiffer than normal, resulting in that there is greater resistance to entry of blood from the lungs. One consequence is stagnation of blood in the pulmonary veins, which can cause fluid to accumulate in the lungs and, consequently, there is a chronic breathlessness. Furthermore, when the ventricular walls thicken, can obstruct blood flow and prevent the proper filling of the heart.
Symptoms and Diagnosis
Symptoms include fainting, chest pain, palpitations caused by irregular heartbeat and heart failure with breathlessness. The irregular heartbeat can cause death repentina.El diagnosis is made from physical examination. For example, heart sounds heard with a stethoscope usually are characteristic.
The diagnosis is usually confirmed with an echocardiogram, an electrocardiogram (ECG) or chest radiography. If you are considering surgery, you may need to practice a cardiac catheterization to measure pressures within the heart.
Prognosis and Treatment
Annually, about 4 percent of people with hypertrophic cardiomyopathy. Death usually occurs suddenly, the death due to chronic heart failure is less common. Genetic counseling is recommended if the disorder is inherited and want to have offspring.
Treatment aims to reduce the resistance of the heart to fill with blood between beats. The main treatment is the administration, jointly or separately, beta blockers and antagonists of calcium channels.
The surgical intervention that removes a portion of heart muscle increases the output of blood from the heart, but only occurs in patients with disabling symptoms despite drug treatment. The surgery improves symptoms but does not reduce the risk of death.
Prior to any dental or surgical intervention, antibiotics are given to reduce the risk of infection of the lining of the heart (endocarditis).
Restrictive cardiomyopathy
Restrictive cardiomyopathy is a group of heart muscle disorders characterized by rigidity of the ventricular walls (which are not necessarily thick), which causes a resistance to normal filling with blood between beats.
It is the least common form of cardiomyopathy and shares many features with hypertrophic cardiomyopathy.
Its cause is unknown. In one of his two basic types, the heart muscle is gradually replaced by scar tissue. In the other type, the muscle is infiltrated by an abnormal substance such as white blood cells.
Other causes of infiltration can be amyloidosis and sarcoidosis. If the body contains much iron, it accumulates in the heart muscle, such as iron overload (hemochromatosis). Finally, this cardiomyopathy might also be the result of a tumor invading the heart tissue.
Because the resistance of the heart to filling the pumped volume is sufficient when the person is at rest, but not when the person is making an effort.
Symptoms and Diagnosis
Restrictive cardiomyopathy causes heart failure with dyspnea and swelling of the tissues (edema). Angina and fainting occur less frequently than in hypertrophic cardiomyopathy, but instead are common arrhythmias and palpitations.
Restrictive cardiomyopathy is one of the possible causes being investigated in case a person has heart failure. The diagnosis is mainly based on physical examination, electrocardiogram (ECG) and echocardiogram.
Magnetic resonance imaging (MRI) can provide additional information about the structure of the heart. Accurate diagnosis requires heart catheterization to measure pressure and a heart muscle biopsy (obtain a sample and its analysis under a microscope), which permits identification of the substance that infiltrates.
Prognosis and Treatment
About 70 percent of patients with restrictive cardiomyopathy die within five years of the onset of symptoms. In most cases, there is no effective treatment.
For example, diuretics, which are generally used to treat heart failure, reduce the volume of blood to the heart and worsen the situation rather than improve it.
The drugs commonly used in heart failure to reduce the overhead of the heart are not too useful because it decreases blood pressure.
Sometimes, the cause of restrictive cardiomyopathy can be treated to prevent injuries from worsening heart or even to partially reverse.
For example, blood drawn at regular intervals reduces the amount of iron stored in people with hemochromatosis. In the case of sarcoidosis, we recommend the administration of corticosteroids.
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