1. Cardiomyopathy
Presented by
Likhila abraham

2.  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

3. Definition
Cardiomyopathy is a
heart muscle disease of
unknown cause (levis)

4. Cardiomyopathy is a
measurable heart deterioration
of the function of the
myocardium leading to heart
failure

5. 2006 AHA defined
cardiomyopathies as “a
heterogeneous group of
diseases of the myocardium
associated with mechanical &/or
electrical dysfunction that
usually (but not invariably)
exhibit inappropriate ventricular
hypertrophy or dilatation and
are due to a variety of causes

6. Etiology
Long term bp
Diseases
Infection
Genetic
Pregnancy
HIV
others

7. The 3 main types of
cardiomyopathy are:
 Dilated
cardiomyopathy
 Hypertrophic
cardiomyopathy
 Restrictive
cardiomyopathy

8. DILATED
CARDIOMYOPATHY

9. 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 and become
thinner

 Ventricular chamber size

over time, the heart becomes weaker
 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
 .

10. Primary (idiopathic) is a disease of unknown
etiology that principally affects the
myocardium leading to LV dilation and
systolic dysfunction
Most common of the cardiomyopathies

12. Clinical features-
 Highest incidence in middle age
 Symptoms may be gradual in onset
 Acute presentation
 Misdiagnosed as viral URI in young adults
 Symptoms/Signs of heart failure
 Pulmonary congestion (left heart failure)
dyspnea (rest, exertional, nocturnal), orthopnea
 Systemic congestion (right heart failure)
edema, nausea, abdominal pain, nocturia
 Low cardiac output
 Hypotension, tachycardia, tachypnea
 Fatigue and weakness
 Arrhythmia
 Atrial fibrillation, conduction delays,,sudden death

13. Hypertrophic cardiomyopathy
 Characterised by myocardial hypertrophy,abnormal
diastolic filling,intermittent ventricular outflow
obstruction
 Related to defects in force generation owing to
altered sarcomeric function
 Leading cause of LVH,unexplained by other
clinical/pathologic cause
 Caused by mutation of genes encoding sarcomeric
proteins

14. 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).

17. 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

18. 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

19. 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.

20. Septal myectomy
- also called septal myomectomy
- is open-heart surgery for hypertrophic obstructive
cardiomyopathy
- generally used in younger patients and when medicines
aren't
working well.
Procedure:
1. a surgeon removes part of the thickened septum that is
bulging
into the left ventricle  this widens the pathway in the
ventricle that leads to the aortic valve and improves blood flow
through the heart and out to the body
2. If necessary, the mitral valve can be repaired or replaced at
the same time. This surgery is often successful, and the person
can return to a normal life with no symptoms.

21. Surgically implanted devices.
- Surgeons can place several different types of devices in the
heart to help it beat more effectively.
1. A left ventricular assist device (LVAD)
- helps the heart pump blood to the body
- LVAD can be used as a long-term therapy or as a short-term
treatment for people who are waiting for a heart transplant.
2. An implantable cardioverter defibrillator (ICD)
- is used in people who are at risk of life-threatening arrhythmia
or sudden cardiac death.
- This small device is implanted in the chest and connected to
the heart with wires. If the ICD senses a dangerous change in
heart rhythm, it will send an electric shock to the heart to
restore a normal heartbeat.
Heart Transplant

24. 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

25. 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.

26. 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.

27. 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

28. Heart Transplant (cont.)

29. 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.
Preventing Rejection
Immunosuppressants used: cyclosporine, tacrolimus, MMF
(mycophenolate mofetil), and steroids such as prednisone.
Watching for Signs of Rejection
Shortness of breath
Fever
Fatigue
Weight gain
Reduced amounts of urine
Preventing Infection

30. Failure of the donor heart
Primary Graft Dysfunction
Rejection of the Donor Heart
Cardiac Allograft Vasculopathy - the walls of the new heart's
coronary arteries become thick, hard, and lose their elasticity. -
can cause heart attack, heart failure, dangerous arrhythmias,
and sudden cardiac arrest
Complications from medicines - risk of infection, diabetes,
osteoporosis , high blood pressure, kidney damage, and cancer
Infection
Cancer – lymphoma and skin cancer (due to suppression of the
immune system)