Cardiomyopathy.
Refers to cardiomyopathies with myocardial dysfunction. There are four types: dilated, hypertrophic, restrictive, and arrhythmogenic right ventricular cardiomyopathy. In recent years, there is “tachycardia cardiomyopathy”.
Dilated cardiomyopathy.
If the enlarged heart, arrhythmia and congestive heart failure are seen clinically, and if echocardiography confirms the enlargement of the heart chambers and the diffuse weakening of the heart, the possibility of this disease is considered, but organic heart disease with various etiologies should be excluded.
Treatment.
General therapy, diuretics, digitalis, beta-blockers, cardiac pacemakers, heart transplantation.
Hypertrophic cardiomyopathy (HCM).
A cardiomyopathy characterized by hypertrophy of the left (or) right ventricle, often asymmetric hypertrophy with involvement of the ventricular key septum, with obstructed left ventricular filling and decreased diastolic compliance as the underlying pathology. It is divided into obstructive (very pronounced septal hypertrophy in the lower aortic valve) and nonobstructive cardiomyopathy.
Clinical manifestations.
Some are asymptomatic and are detected by stroke or on physical examination. Many patients have palpitations, chest pain, and exertional dyspnea. Those with outflow tract obstruction may experience vertigo and loss of consciousness on rising or exercise due to inadequate diastolic filling of the left ventricle and reduced cardiac output. Physical examination may include enlarged heart, fourth sound; outflow tract obstruction in the 3rd-4th intercostal interval rougher systolic murmur; systolic murmur can often be heard in the apical part of the heart.
In addition to the relative stenosis of the left ventricular outflow tract caused by asymmetric hypertrophy of the septum, the above two murmurs are mainly due to the funnel effect of systolic blood flow passing through the stenosis shifting the mitral valve toward the septum to make the stenosis more severe, and in late systole any to can completely block the outflow tract; and at the same time the mitral valve appears to be closed incompetently.
Restrictive cardiomyopathy.
This is characterized by uni- or bi-ventricular filling restriction and reduced diastolic volume, but normal or near-normal systolic function and wall thickness. The main pathological changes are interstitial fibrotic proliferation of the heart, both subendocardial and endocardial with several millimeters of fibrous thickening, sclerosis of the ventricular endocardium, and markedly restricted dilatation. It may be idiopathic or coexist with other diseases such as amyloidosis, with or without eosinophilia in endocardial myocardial disease.
Clinical manifestations.
Fever and generalized lethargy are the initial symptoms, and increased WBCs, especially eosinophilia, are more specific. Later on, palpitations, dyspnea, swelling, hepatomegaly, strong venous anger, and ascites gradually appear. Its performance resembles constrictive pericarditis, and some people call it constrictive endocarditis.
Electrocardiogram.
Sinus tachycardia, low voltage, atrial or ventricular hypertrophy, low or inverted T waves, various arrhythmias, mostly atrial fibrillation.
Left ventriculogram.
Endocardial thickening and narrowing of the cardiac chambers with obtuse apical angulation.
Differential diagnosis: constrictive pericarditis, mild CHD, hypertrophic, dilated cardiomyopathy and some diseases with extensive cardiac fibrosis such as systemic sclerosis, diabetes mellitus, alcohol moderate and other idiopathic cardiomyopathies.
Arrhythmogenic right ventricular cardiomyopathy (ARVC).
Characterized by replacement of the right ventricular myocardium by progressive fibrofatty tissue, typically regional in the early stages and then gradually involving the entire right ventricle and even parts of the left heart. There is a family history of autosomal dominant inheritance, manifested by arrhythmias, right heart macrosomia and sudden death, by its in young people. Treatment: Arrhythmia control, endomyocardial biopsy and ablation are not recommended, ICD, heart transplantation. In recent years, there is “tachycardia cardiomyopathy”.
Idiopathic cardiomyopathy.
This is a disease of the heart muscle with an atopic heart disease or an atopic systemic disease.