Cardiomyopathy Clinical Manifestations

Cardiomyopathy Clinical Manifestations

• Cardiomyopathies weaken the heart and decrease its ability to pump blood and maintain regular rhythm.

Dilated Cardiomyopathy (DCM)

• DCM symptoms develop gradually.
• Heart failure (HF) often emerges years after the onset of dilation and cardiac failure.
• HF symptoms include dyspnea on exertion, orthopnea, fatigue, paroxysmal nocturnal dyspnea, weakness, peripheral edema, and ascites.
• S3 and S4 heart sounds are common, as well as an AV regurgitation murmur.
• Dysrhythmias are common as DCM progresses.
• Ventricular dysrhythmias increase the risk of sudden death.

Hypertrophic Cardiomyopathy (HCM)

• HCM can cause angina due to ventricular muscle overgrowth, coronary artery abnormalities, or decreased coronary artery perfusion.
• Syncope (temporary loss of consciousness) can occur due to outflow tract obstruction, severely decreasing cardiac output and cerebral blood flow.
• Ventricular dysrhythmias and atrial fibrillation are common.
• Other symptoms include dyspnea, fatigue, dizziness, and palpitations.
• A harsh systolic ejection murmur is characteristic in HCM, heard best at the lower left sternal border and apex.
• An S4 murmur may also be present.

Restrictive Cardiomyopathy (RCM)

• Patients with RCM may remain asymptomatic or experience minimal symptoms.
• Common symptoms include fatigue, dyspnea on exertion, and peripheral edema.
• Less common symptoms include fainting and chest pain/pressure during exercise or rest.
• Elevated jugular venous pressure (JVP) is common, and S3 and S4 heart sounds are also typical.

Arrhythmogenic Right-Ventricular Dysplasia (ARVD)

• Usually diagnosed in patients under age 40.
• Often asymptomatic, with sudden death as the first manifestation.
• Dysrhythmias and conduction disturbances are common symptoms.

Transthyretin Amyloid Cardiomyopathy (ATTR-CM)

• Often diagnosed in people with a family history of ATTR-CM or HF.
• Diagnosis confirmed by cardiac MRI/nuclear medicine heart scan, cardiac tissue biopsy, and/or genetic testing.

Unclassified Cardiomyopathy

• Includes a variety of primary heart muscle diseases that result in cardiac dysfunction.
• Manifestations vary depending on the specific disease.

Cardiomyopathy Clinical Therapies

• Treatment of underlying cause is vital.
• Medications:
  • Diuretics
  • Vasodilators
  • Beta-adrenergic blockers
  • Calcium channel blockers (CCBs)
  • Antidysrhythmics
  • Nitrates
• Daily monitoring of patient's weight and fluid intake and output is important.
• Elastic stockings to improve venous return.
• Abdominocentesis to reduce ascites.
• Sleep in a semi-Fowler position to promote breathing.
• Periods of activity followed by periods of rest is recommended.
• An implantable cardioverter-defibrillator (ICD) may be required.
• Patient teaching regarding awareness of pulse rate and rhythm and when to contact healthcare team is essential.
• Surgery may be required to repair damaged coronary arteries.
• Patient teaching about the importance of sitting down as soon as syncope symptoms start to prevent falls is vital.