Definition

The disease that coming from heart muscle and effect cardiac fungtion is known Cardiomyopathy. The most common cardiomyopathy are DCM (Dilated Cardiomyopathy), HCM (Hypertrophic Cardiomyopathy), RCM (Restrictive Cardiomyopathy). In all 3 types of Cardiomyopathy, patients may exprience heart failure.



A. Restrictive Cardiomyopathy

There is change in the composition of the heart muscle, that is the muscle become stiff and noncompliant,sistolic function in Restrictive Cardiomyopathy may remain near normal but ventricles are not able to relax properly, diastolic filling reducing leading to systemic and pulmonary venous congestion.



Signs and Symptoms
Signs and symptoms of cardiac failure like: Bradycardia,neck vein distention, peripheral edema, liver congestion, abdominal ascites.
Fatigue, weaknes
Late signs include nocturnal dyspnea, Heart sound S3, pink proty sputum, cough, crackles, orthopnea, tachycardia and restlessness
It is important to try to differentiate between restrictive and constrictive pericarditis, the most effective diagnostic tool for making this distinction are magnetic resonance imaging (MRI).


Test Diagnostic

EKG--> detect abnormalities in heart`s electrical activity
Echocardiography (Echo)--> to show enlarge heart muscle
MRI --> to detect abnormal texture in heart muscle
Cardiac Catheterization --> meassure pressure in heart chambers
Biopsy --> identifies infiltrating substance


Treatment

Around 70% of patients die within 5 years of symptom development, medications not helpful. remove of blood at regular interval to reduce amount of stored iron in clients with iron overload, heart transplant need it.




B. Hypertrophic Cardiomyopathy
The main causes for hypertrophic cardiomyopathy is some higher presser in the systemic vascular like any blood obtruction to pass out from left ventricle.

Uncontrolled hypertension causes ventricle and septum muscle to become hypertrophic. The actual chambers of the heart to become very small and little volume ejects out of the heart, decreasing CO so less forward flow leads to backward flow. (See pic 1)










(Pic : 1 A= Normal heart B= Hypertrophic Cardiomyopathy)




Inherited gene ---> The inherited gene effect the cells of the myocardium so that there is hypertrophy and asymmetry of the left ventricle.
Acromegaly ---> Excessive growth of the heart muscle due to overproduction of growth hormone.

Valvular heary diseases, increased volume or increased resistance to out flow in the chamber of the heart over time distends the chambers and the muscle become stretched, thinned and weakened.


Signs and Symptoms

Many patients with HCM (hypertrophic cardiomyopathy) remain asymptomatic for a long periode of time.
If symptomatic is reported manifestations of HCM are shortness of breath, orthopnea, dyspnea on exertion, nocturnal dyspnea, fatigue, generalize weaknes, dry cough at night.
Peripheral edema, hepatomegaly, jugular vein distension, weight gain.



Test Diagnostic

Chest X-ray --> will show mild to moderate increase in heart size
Thalium scan --> to reveal myocardial perfusion defects
ECHO -> will show left ventricular hypertrophy and thick interventricular septum
Cardiac catheterization --> to meassure pressure in the heart chambers
EKG --> will show left ventricilar hypertrophy, ventricular and atrium arrhytmias.


Treatment

Beta-adrenergis blockers --> to slow heart rate, to reduce myocardial O2 demand, increase ventricular filling by relaxing obstructing muscle.
Calcuim channal blockers--> to increase ventricular filling by relaxing obstructing muscle.
Antiarrhymic drugs --> to control arrhytmias
Anti coagulants --> to reduce risk of systemic embolism with atrial fibrilation
Heart transplant --> to replace the damage heart




C. Dilated Cardiomyopathy


In patient with dilated cardiomyopathy the left ventricle become dilated, resulting in impaired contraction. Those are possible caused :

Chemotheraphy ---> Toxic effect of the drugs on the myocardial cell dilate the ventricles and they can not contract properly.
Alcohol and drugs ---> Direct toxic effect of alcohol on the myocytes( cardiac cells)
Coronary heart diseaes---> Decrease O2 delivery to the heart muscle leads to pump failure.
Valvular heary diseases ---> increased volume or increased resistance to out flow in the chamber of the heart over time distends the chambers and the muscle become stretched, thinned and weakened. ( See pic 2)











( pic:2 A=Normal heart B= Dilated Cardiomyopathy)



Signs and Symptoms

Clients will increasingly display signs and symptoms of heart failure
Peripheral edema , hepatomegaly, jugular vein distension, and weight gain.
Peripheral cyanosis, tachycardia, murmur, arrhythmia, chest pain, palpitation, syncope.



Test Diagnostic

Angiography --> to rule out ischemic heart disease
Chest X-ray --> will show moderate to marked cardiomegaly and pulmonary edema
Echocardiography --> to confirm degree of left ventricular dilation and dysfunction
EKG --> to rule out ischemic heart disease
Cardiac catheterization
Endomyocardial biopsy.



Treatment

O2 therapy
ACE Inhibitors --> to reduce afterload through vasodilation
Diuretic --> to reduce fluid retention
Beta-adrenergic blockers --> to reduce demand
Antiarrhymic drugs --> to control arrhytmias
Valvular repair or replacement --> to manage dilated cardimyopathy fro valve dysfunction
Heart transplant --> to replace the damage heart
Lifestyle modifications