Background

Denition Denition
NOTE:
Ischemic CMP is
similar than
dilated CMP but
by denition
NOT a form of
dil. CMP!
Primary myocardial disease
NOTE:
Ischemic CMP is
similar than
dilated CMP but
by denition
NOT a form of
dil. CMP!
Impaired systolic function
NOTE:
Ischemic CMP is
similar than
dilated CMP but
by denition
NOT a form of
dil. CMP!
Dilatation
NOTE:
Ischemic CMP is
similar than
dilated CMP but
by denition
NOT a form of
dil. CMP!
Causes Causes
NOTE:
Etiology is often
not found
because biopsie
is not
performed!
Idiopathic (50%)
NOTE:
Etiology is often
not found
because biopsie
is not
performed!
Myocarditis (9%)
NOTE:
Etiology is often
not found
because biopsie
is not
performed!
Ischemic heart disease (9%)
NOTE:
Etiology is often
not found
because biopsie
is not
performed!
Peripartum CMP (7%)
NOTE:
Etiology is often
not found
because biopsie
is not
performed!
Inltrative disease (5%)
NOTE:
Etiology is often
not found
because biopsie
is not
performed!
Associated Problems Associated Problems Associated Problems
Left heart failure Atrial brillation
Pulmonary hypertension Mitral regurgitation
Right heart failure Tricuspid regurgitation
Dyssynchrony Thromboembolism
Echofeatures
Diagnosis Diagnosis
NOTE:
Endstage
ischemic
CMP and
dilated CMP
look very
similar!
Reduced LVF
NOTE:
Endstage
ischemic
CMP and
dilated CMP
look very
similar!
Dilated LV
NOTE:
Endstage
ischemic
CMP and
dilated CMP
look very
similar!
Reduced -RVF
NOTE:
Endstage
ischemic
CMP and
dilated CMP
look very
similar!
Exclude other causes (CAD, valvular)
NOTE:
Endstage
ischemic
CMP and
dilated CMP
look very
similar!
005 // Dilated Cardiomyopathy
1
Severity Severity
Low output Reduced LVF, LVOT vel < 0.5m/sec
Atrial size Small atria
Diastolic function /
lling pressure
Pseudonormal / restricitive pattern
Causes of Mitral regurgitation in CMP Causes of Mitral regurgitation in CMP
NOTE:
MR increases
mortality!
additional
volume
overload of LV
Dyssynchrony
NOTE:
MR increases
mortality!
additional
volume
overload of LV
Shape
NOTE:
MR increases
mortality!
additional
volume
overload of LV
LVF
NOTE:
MR increases
mortality!
additional
volume
overload of LV
Tenting
NOTE:
MR increases
mortality!
additional
volume
overload of LV
Annulus
NOTE:
MR increases
mortality!
additional
volume
overload of LV
Markers of poor prognosis Markers of poor prognosis
Very severe LV-dysfunction Reduced RVF
Verly large LV MR
Elevated LVEFP
Specic Forms
Ischemic CMP
most common cause of heart
failure
Tako Tsubo CMP
stress induced CMP
(apical ballooning, reversible),
normal coronary arteries
Peripartum CMP
Myocardits? Risk factors: age >
30 years, multiparity
pre-, eclampsia
postpartum hypertension
Tachycardia mediated
CMP
atrial, ventricular tachycardia
reversible
Arrythmia mediated CMP ectopic beats > 17.000/24h
005 // Dilated Cardiomyopathy
2
LV NonCompaction LV NonCompaction
Characterized by prominent
trabeculae and intertrabecular
recessi
Associated with other
cardiac abnormalities
Genetic disease, Risk of CMP,
Family screening!
Associated with
neuromuscular disorders
Chagas Disease Chagas Disease Chagas Disease
Trypanosoma cruzi Megaesophagus
Cardiac disease Megacolon
Most common form of CMP in Latin-America Most common form of CMP in Latin-America
Right heart failure dominant regional + global
dysfunction
Right heart failure dominant regional + global
dysfunction
005 // Dilated Cardiomyopathy
3