Cardiomyopathy Etiology Clinical Presentation Evaluation Therapy

Dilated End stage hypertropic Left side systolic HF Echo or nuclear: measure Salt and water retention
disease symptoms EF
Reduced ventricular EF Cardiomegaly Preload and afterload
Multi-infarct or Echo: measure LV wall reduction
High EDV/pressure ischemic disease LV/RV heave motion/function and
chamber size (shows Inotrope
Reduced CO Toxins (ie. OH) S3 dilation)
AA
High pulmonary capillary wedge Infections (myocarditis) Occasional mitral or tricuspid ECG: signs of ischemia or
pressure regurg arrhythmia Transplant or assist
Endocrinopathy (DM, device
Natural History: thyroid) JVD NYHA1-4: functional
- w/o ischemia: 3 yr. mortality capacity
30% CT disease Pulmonary rales/peripheral
- w/ ischemia: prognosis edema Labs: electrolytes, thyroid,
twice as poor Muscular dystrophy glucose
- 60% w/ myocarditis resolve Occasional arrhythmia
completely Post partum Stress or cath: ischemia
Fatigue, exertional dyspnea,
orthopnea Detailed history

Myocardial biopsy
Restrictive Infiltrative disease Similar to dilated Diagnosis of exclusion: Judicious preload
(sacroid, amyloid, cardiomyopathy CHF in presence of reduction
Normal systolic contractility hemochromatosis) normal systolic function
S4 more common than S3 Direct therapy to
Reduction in diastolic relaxation TB Echo: LV size and underlying disease
and filling capacity Resting tachy function (normal but
DM abnormal diastolic B-blocker/Ca-blocker
High resting LV and diastolic filling No LV dilation function) (aid in relaxation
pressure Fibroelastosis
Valvular dysfunction less NYHA1-4: functional
High pulmonary wedge pressure, common capacity
especially w/ exercise
Labs: glucose, ferritin
Diastolic dysfunction without
hypertrophic LV PPD

Myocardial biopsy
Cardiomyopathy Etiology Clinical Presentation Evaluation Therapy
Hypertropic Genetic: Autosomal Sudden death 2D echo: essential- shows Avoid: vigorous
dominant-inherited LV enlargement and LAD physical activity;
Myositis in disarray disorder of sarcomere Palpitations/arrhythmias preload/afterload
length Physical exam reducing agents
May hypertrophy asymmetrically, Chest pain characteristic
obstructing outflow (LV small cavity Associated with young Myomectomy
size) atheletes Dizziness/syncope Family history revealing
Septal ablation w/
Outlet obstruction obstruction pulls Bifid carotid upstroke ECG: ST changes catheters
anterior mitral leaflet out of position,
causing regurg (because the flow Basilar systolic murmur B-blocker/Ca-blocker or
velocity in LVOT pulls ant mitral disopyramide (aid in
leaflet) Resting tachy frequent slowing HR and
relaxation)
LV filling volumes reduced due to
diastolic stiffness Electronic pacing

High pulmonary capillary wedge

pressure

Pulmonary hypertension

Normal LV systolic contractility