Cardiomyopathy
(literally "heart muscle disease") is the measurable deterioration for any reason of the ability of the myocardium (the heart muscle) to contract, usually leading to heart failure. Common symptoms include dyspnea and peripheral edema.
Those with cardiomyopathy are often at risk of dangerous forms of
irregular heart rate and sudden cardiac death.
The most common form of cardiomyopathy is dilated cardiomyopathy.
Although the term "cardiomyopathy" could theoretically apply to almost any disease affecting the heart, it is usually reserved for "severe myocardial disease leading to heart failure."
Differential diagnosis
Cardiomyopathies are either confined to the heart or are part of a generalized disorder, both often leading to death or progressive heart failure. Other diseases that cause heart muscle dysfunction are excluded, such as
coronary artery disease,
hypertension, or abnormalities of the heart valves.
Earlier, simpler, categories such as intrinsic, (defined as weakness of the heart muscle without an identifiable external cause), and extrinsic, (where the primary pathology arose outside the myocardium itself), became more difficult to sustain.
For example, as more external causes were recognized, the intrinsic category became smaller. Alcoholism, for example, has been identified as a cause of dilated cardiomyopathy, as has drug toxicity, and certain infections
(including Hepatitis C).
On the other hand, molecular biology and genetics have given rise to the recognition of various genetic causes, increasing the intrinsic category. For example, mutations in the cardiac desmosomal genes as well as in the DES gene may cause arrhythmogenic right ventricular cardiomyopathy (ARVC).
At the same time, a more clinical categorization of cardiomyopathy as 'hypertrophied', 'dilated', or 'restrictive', became difficult to maintain when it became apparent that some of the conditions could fulfill more than one of those three categories at any particular stage of their development. The current American Heart Association definition divides cardiomyopathies into primary, which affect the heart alone, and secondary, which are the result of illness affecting other parts of the body. These categories are further broken down into subgroups which incorporate new genetic and molecular biology knowledge.
Types
Cardiomyopathies can be classified using different criteria:
Primary/intrinsic
cardiomyopathies Genetic
Hypertrophic cardiomyopathy
Arrhythmogenic right ventricular cardiomyopathy (ARVC)
LV non-compactionIon Channelopathies
Dilated cardiomyopathy (DCM)
Restrictive cardiomyopathy (RCM)
Acquired
Stress Cardiomyopathy
MyocarditisIschemic cardiomyopathy
Secondary/extrinsic cardiomyopathies
Metabolic/storage
Fabry’s disease
hemochromatosis
Endomyocardial
Endomyocardial fibrosis
Hypereosinophilic syndrome
Endocrine
diabetes mellitus
hyperthyroidis
macromegaly
Cardiofacial
Noonan syndrome
Neuromuscular
@muscular dystrophy
Friedreich’s ataxia
Other
Obesity-associated cardiomyopathy
Diagnosis
Among the diagnostic procedures done to determine a cardiomyopathy are:
Physical exam
Family history
Blood test
ECG
Echocardiogram
Stress test
Genetic testing
Treatment
Treatment may include suggestion of lifestyle changes to better manage the condition.
Treatment depends on the type of cardiomyopathy and condition of disease, but may include medication (conservative treatment) or iatrogenic/implanted pacemakers for slow heart rates, defibrillators for those prone to fatal heart rhythms,
ventricular assist devices (VADs) for severe heart failure, or ablation for recurring dysrhythmias that cannot be eliminated by medication or mechanical cardioversion. The goal of treatment is often symptom relief, and some patients may eventually require a heart transplant.
(literally "heart muscle disease") is the measurable deterioration for any reason of the ability of the myocardium (the heart muscle) to contract, usually leading to heart failure. Common symptoms include dyspnea and peripheral edema.
Those with cardiomyopathy are often at risk of dangerous forms of
irregular heart rate and sudden cardiac death.
The most common form of cardiomyopathy is dilated cardiomyopathy.
Although the term "cardiomyopathy" could theoretically apply to almost any disease affecting the heart, it is usually reserved for "severe myocardial disease leading to heart failure."
Differential diagnosis
Cardiomyopathies are either confined to the heart or are part of a generalized disorder, both often leading to death or progressive heart failure. Other diseases that cause heart muscle dysfunction are excluded, such as
coronary artery disease,
hypertension, or abnormalities of the heart valves.
Earlier, simpler, categories such as intrinsic, (defined as weakness of the heart muscle without an identifiable external cause), and extrinsic, (where the primary pathology arose outside the myocardium itself), became more difficult to sustain.
For example, as more external causes were recognized, the intrinsic category became smaller. Alcoholism, for example, has been identified as a cause of dilated cardiomyopathy, as has drug toxicity, and certain infections
(including Hepatitis C).
On the other hand, molecular biology and genetics have given rise to the recognition of various genetic causes, increasing the intrinsic category. For example, mutations in the cardiac desmosomal genes as well as in the DES gene may cause arrhythmogenic right ventricular cardiomyopathy (ARVC).
At the same time, a more clinical categorization of cardiomyopathy as 'hypertrophied', 'dilated', or 'restrictive', became difficult to maintain when it became apparent that some of the conditions could fulfill more than one of those three categories at any particular stage of their development. The current American Heart Association definition divides cardiomyopathies into primary, which affect the heart alone, and secondary, which are the result of illness affecting other parts of the body. These categories are further broken down into subgroups which incorporate new genetic and molecular biology knowledge.
Types
Cardiomyopathies can be classified using different criteria:
Primary/intrinsic
cardiomyopathies Genetic
Hypertrophic cardiomyopathy
Arrhythmogenic right ventricular cardiomyopathy (ARVC)
LV non-compactionIon Channelopathies
Dilated cardiomyopathy (DCM)
Restrictive cardiomyopathy (RCM)
Acquired
Stress Cardiomyopathy
MyocarditisIschemic cardiomyopathy
Secondary/extrinsic cardiomyopathies
Metabolic/storage
Fabry’s disease
hemochromatosis
Endomyocardial
Endomyocardial fibrosis
Hypereosinophilic syndrome
Endocrine
diabetes mellitus
hyperthyroidis
macromegaly
Cardiofacial
Noonan syndrome
Neuromuscular
@muscular dystrophy
Friedreich’s ataxia
Other
Obesity-associated cardiomyopathy
Diagnosis
Among the diagnostic procedures done to determine a cardiomyopathy are:
Physical exam
Family history
Blood test
ECG
Echocardiogram
Stress test
Genetic testing
Treatment
Treatment may include suggestion of lifestyle changes to better manage the condition.
Treatment depends on the type of cardiomyopathy and condition of disease, but may include medication (conservative treatment) or iatrogenic/implanted pacemakers for slow heart rates, defibrillators for those prone to fatal heart rhythms,
ventricular assist devices (VADs) for severe heart failure, or ablation for recurring dysrhythmias that cannot be eliminated by medication or mechanical cardioversion. The goal of treatment is often symptom relief, and some patients may eventually require a heart transplant.
