Cardiomyopathy: Types, Causes, and Management PDF

Cardiomyopathy  Cardiomyopathy  disease of the heart muscle in which the heart loses its ability to pump blood effectively  the heart muscle becomes enlarged or abnormally thick or rigid.  In rare cases, the muscle tissue in the heart is replaced with scar tissue.  As cardiomyop...

Cardiomyopathy  Cardiomyopathy  disease of the heart muscle in which the heart loses its ability to pump blood effectively  the heart muscle becomes enlarged or abnormally thick or rigid.  In rare cases, the muscle tissue in the heart is replaced with scar tissue.  As cardiomyopathy progresses  the heart becomes weaker and less able to pump blood through the body  to heart failure, arrhythmias, systemic and pulmonary edema and, more rarely, endocarditis The 3 main types of cardiomyopathy are: ◆ Dilated cardiomyopathy ◆ Hypertrophic cardiomyopathy ◆ Restrictive cardiomyopathy  Dilated Cardiomyopathy ◆ most common form of cardiomyopathy ◆ generally occurs in adults aged 20 to 60 years ◆ more common in men  the heart muscle begins to dilate or stretch   Ventricular chamber size  over time, the heart becomes weaker  heart failure  symptoms of heart failure: fatigue, edema, and SOB  can also lead to heart valve problems (regurgitation), arrhythmias, and blood clots in the heart (poor blood flow), emboli formation  Types and Causes: ◆ Ischemic cardiomyopathy - caused by CAD & MI , Idiopathic cardiomyopathy - the cause is unknown. ◆ Hypertensive cardiomyopathy - seen in people who have high BP for a long time, ◆particuarly when it has gone untreated for years. Infectious cardiomyopathy - HIV, viral myocarditis ◆ Alcoholic cardiomyopathy - usually begins about 10 years after sustained, heavy ◆alcohol consumption. Toxic cardiomyopathy – due to cocaine, amphetamines, and some chemotherapy drugs. ◆ Peripartum cardiomyopathy: This type appears in women during the last trimester of pregnancy or after childbirth. ◆ Radiotherapy (cobalt) diabetes and thyroid disease ◆ ◆  Hypertrophic Cardiomyopathy  occurs when the heart muscle thickens abnormally (left ventricle)  1.) obstructive type - the septum thickens and bulges into the left ventricle blocks the flow of blood into the aorta  the ventricle must work much harder to pump blood past the blockage and out to the body - symptoms can include chest pain, dizziness, shortness of breath, or fainting. - can also affect the mitral valve, causing blood to leak backward through the valve. 2.) non-obstructive type - the entire ventricle may become thicker (symmetric ventricular hypertrophy) or it may happen only at the bottom of the heart (apical hypertrophy). The right ventricle also may be affected.  Hypertrophic Cardiomyopathy Pathophysiology: Left ventricular hypertrophy (thick ventricular wall)   ventricular chamber size  hold less blood   CO  pressure in the ventricles and lungs changes in the cardiac muscles  interfere with the heart's electrical signals, leading to arrhythmias  sudden cardiac arrest Causes: ◆ inherited because of a gene mutation ◆ develop over time because of high blood pressure or aging ◆ often, the cause is unknown.  Restrictive Cardiomyopathy ◆ tends to mostly affect older adults ◆ the ventricles become stiff and rigid due to replacement of the normal heart muscle with abnormal tissue, such as scar tissue. ◆ As a result, the ventricles cannot relax normally and expand to fill with blood, which causes the atria to become enlarged. ◆ Eventually, blood flow in the heart is reduced, and complications such as heart failure or arrhythmias occur. Causes: ◆ radiation treatments, infections, or scarring after surgery ◆ Hemochromatosis - a condition in which too much iron is deposited into tissues, including heart tissue ◆ Amyloidosis, a disease in which abnormal proteins are deposited into heart tissue  Major Risk Factors ◆ Having a family history of cardiomyopathy, heart failure, or sudden cardiac death ◆ Having a disease or condition that can lead to cardiomyopathy, such as: ◆ Coronary artery disease A ◆ previous heart attack Myocarditis ◆ ◆ Long-term alcoholism ◆ Long-term high blood pressure ◆ Diabetes and other metabolic diseases  Signs and Symptoms ◆ some have no symptoms in the early stages of the disease ◆ as cardiomyopathy progresses and the heart weakens, signs and symptoms of heart failure usually appear. These signs and symptoms include: ◆ Tiredness ◆ Weakness ◆ Shortness of breath after exercise or even at rest ◆ Swelling of the abdomen, legs, ankles, and feet ◆Other signs and symptoms: dizziness, lightheadedness, fainting during exercise, abnormal heart rhythms, murmurs  Interventions The main goals of treating cardiomyopathy are to: ◆ Manage any conditions that cause or contribute to the cardiomyopathy ◆ Control symptoms so that the person can live as normally as possible ◆ Stop the disease from getting worse Reduce complications and the chance of sudden cardiac death Medications: ◆ ◆ Diuretics, which remove excess fluid and sodium from the body. ◆ Angiotensin-converting enzyme (ACE) inhibitors, which lower blood pressure and reduce stress on the heart. ◆ Beta-blockers, which slow the heart rate by reducing the speed of the heart's contractions. These medicines also lower BP ◆ Calcium channel blockers, which slow a rapid heartbeat by reducing the force and rate of heart contractions, decrease BP  Medications Digoxin - ◆ increases the force of heart contractions and slows the heartbeat. ◆Anticoagulants, which prevent blood clots from forming. Anticoagulants are often used in the treatment of dilated cardiomyopathy. Antiarrhythmia medicines, which keep the heart beating in a normal rhythm. ◆ ◆Antibiotics, which are used before dental or surgical procedures. Antibiotics help to prevent endocarditis, an infection of the heart walls, valves, and vessels. ◆ Corticosteroids, which reduce inflammation. Left Ventricular Assist Device (LVAD)  Lifestyle Changes ◆ The doctor may recommend lifestyle changes to manage a condition that is causing the cardiomyopathy. These changes may help reduce symptoms. Lifestyle changes may include: ◆ Quitting smoking ◆ Losing excess weight ◆ Eating a low-salt diet ◆ Getting moderate exercise, such as walking, and avoiding strenuous exercise ◆ Avoiding the use of alcohol and illegal drugs ◆ Getting enough sleep and rest ◆ Reducing stress ◆ Treating underlying conditions, such as diabetes and high blood pressure  Physiotherapy Advice about exercise is complex. This is because every individual is different in how their condition and exercise affects them, there is little scientific research into the role of exercise in cardiomyopathy and so no definitive advice can be given, and there are legal implications of giving advice. General recommendations for exercise for people with cardiomyopathy are: to participate in 'recreational' (for fun) exercise to avoid moderate, intensive or competitive sports to avoid exercise that involves sudden bursts of exertion (such as weight lifting, sprinting). Suitable types of exercise include walking, jogging, easy cycling, swimming, skipping, golf, non- strenuous hiking, tennis, bowling and low-impact aerobics. Conti… Most people with cardiomyopathy will have exercise tests as part of their diagnosis. These tests include: Six Minute Walk Test Cardiopulmonary Exercise Testing (CPET) In Adults Exercise echocardiogram - doing exercise while their heart is being imaged (an 'echo'). Borg Rating Of Perceived Exertion (Intense exercise on this scale is not recommended for people with cardiomyopathy because it places too much exertion on the heart). Advice client when exercising that it is important to stop and seek advice from your GP or cardiologist if experiencing: Chest pain or tightness. Dizzy or light-headedness. Breathlessness (dysponea) Sudden palpitations (being aware of a change in heart rate or rhythm). If any of the symptoms you normally experience become worse when you exercise. HEART TRANSPLANTATION  Heart Transplant ◆ an operation in which the diseased heart in a person is replaced with a healthy heart from a deceased donor. ◆ 90% of heart transplants are performed on patients with end-stage heart failure --- condition has become so severe that all treatments, other than heart transplant, have failed. Survival rates: ◆ 88 % of patients survive the first year after transplant ◆ 72 % survive for 5 years ◆ 50 % survive for 10 yrs. ◆ 16 % survive 20 years.  Heart Transplant (cont.) ◆ Patients who might not be candidates for heart transplant surgery, because the procedure is less likely to be successful. ◆ Advanced age - most transplant surgery isn't performed on patients older than 70 years. ◆ Poor blood circulation throughout the body, including the brain. ◆ Diseases of the kidney, lungs, or liver that can't be reversed. ◆ History of cancer or malignant tumors. ◆ Inability or unwillingness to follow lifelong medical instructions after a transplant. ◆ Pulmonary arterial hypertension (high blood pressure in the lungs) that can't be reversed. ◆ Active infection throughout the body.  Heart Transplant (cont.) ◆ Organs are matched for blood type and size of donor and recipient. ◆ The Donor Heart Guidelines on how a donor heart is selected :  the donor meet the legal requirement for brain death  consent forms are signed  younger than 65 years of age  have little or no history of heart disease or trauma to the chest  not exposed to hepatitis or HIV  donor heart must be transplanted w/in 4 hrs. after removal from the donor  Heart Transplant (cont.) ◆ A bypass machine is hooked up to the arteries and veins of the heart. The machine pumps blood through the patient's lungs and body while the diseased heart is removed and the donor heart is sewn into place. ◆ Watching for Signs of Rejection ◆ Shortness of breath Fever Fatigue Weight gain Reduced ◆amounts of ◆urine ◆ Preventing Infection