Cardiomyopathy : symptoms, treatment , causes, prognosis


  • Classification of diseases
  • Why there cardiomyopathy
  • Symptoms Pathology
  • Dangers cardiomyopathy
  • Diagnostics
  • Treatment
  • Hospitalization
  • prognosis of cardiomyopathies

The term "cardiomyopathy" consists of three parts, its deciphering:

  • «cardio" - heart;
  • «myo" - associated with the defeat of the muscle layer;
  • «-patiya" - non-inflammatory disease and non-neoplastic nature.

linking all three parts together, it turns out that cardiomyopathy - heart muscle damage this layer (called the myocardium), which arose not as a result of inflammation or swelling.It has a disease such binding characteristics:

  • suffers not only the body of the function, but also impaired myocardial structure - it thickens;
  • it is not associated with a disease of the coronary arteries that supply the heart itself (the defeat of the arteries is the basis of coronary heart disease);
  • pathology arose not because of rheumatic fever or other causes of violations of the structure of the heart valves;
  • disease is not associated with hypertension, tumors or congenital heart disease.When

cardiomyopathies myocardial cells appear in the products of their metabolism, which may be different from the number of rules, or they may be modified in structure.This prevents the body work effectively, leading to the rapid development of heart failure and the appearance of arrhythmias.

Diagnosis is based on the data of instrumental studies that can visualize the heart and calculate the characteristics of his work (ultrasound, magnetic resonance and computer tomography), but only - after excluding valve, tumor, ischemic or hypertensive disease as the underlying cause.

disease Classification

Cardiomyopathy can be:

  1. primary - or when the cause is unknown, or it is impossible to influence (eg, gene defect);
  2. secondary when the cause can be found.

Primary cardiomyopathy has its classification, where each sub-species differs in its reason, main symptoms and approaches to treatment.So, it happens:

  • dilated;
  • hypertrophic;
  • restrictive;
  • arrhythmogenic right ventricular.

Classification of secondary pathology based on the cause of the disease.So, cardiomyopathy is:

  • dyshormonal (including thyrotoxic, diabetic and menopausal);
  • dismetabolic;
  • ischemic;
  • toxic (including alcohol);
  • Takotsubo;
  • alimentary.

Why there cardiomyopathy

Causes of cardiomyopathy will differ depending on the type of disease.That is, due to a combination of reasons is a certain type of disease.We consider these in more detail.

Dilated cardiomyopathy

term "dilated cardiomyopathy" refers to a pathology where chambers of the heart (especially the ventricles) are expanding beyond measure.Because of this, the force of negative pressure in the ventricles during systole is sucked more blood.By this heart, which expanded by thinning its walls that simultaneously reduced the strength of his muscles, is not ready.There is the following mechanism:

  1. first heart tries to increase its power reductions, but this leads to an increase in its oxygen requirements, leading to myocardial ischemia;
  2. heart contracts more often than it should, which allows to cover the some time the body's need for oxygen;
  3. spite of the above two mechanisms, heart cavity so large that the entire push blood volume during systole is not.The residual volume remaining in the ventricles, stretches them even more;
  4. extension wall "pulls" for himself and valves - "petals" of the connective tissue between the atria and ventricles.As a result, the valves may not fully close after release into the blood vessels of the blood and returned to the ventricles, further increasing the residual volume and, accordingly, further stretching the heart.This leads to the appearance of symptoms of heart failure.

reasons for dilated cardiomyopathy is considered:

  • defective genes responsible for normal pattern of myocardial cells - the cause of every third-fifth of the disease;
  • enteroviruses;
  • hepatitis C;
  • SARS;
  • transferred borreliosis;
  • own appearance of antibodies to different proteins of cardiac cells, such as tropomyosin, actin or laminin;
  • toxic substances (eg, alcohol);
  • endocrine diseases.

By dilated form also applies ischemic cardiomyopathy - a condition where the heart cavity expands due to coronary heart disease (CHD), when the myocardium no longer cope with the insufficient intake of oxygen to it.

Hypertrophic cardiomyopathy

This pathology of the myocardium, in which the weight is increased and the thickness of the heart muscle, often - in the left ventricle, but may be in the right, and in the interventricular septum.A similar process can occur symmetrically, that is the same in all parts of the (symmetric hypertrophy), or mainly, in the area of ​​the interventricular septum (asymmetric cardiomyopathy).

second classification involves dividing hypertrophic cardiomyopathy on:

  • obstructive form - when the muscle increases in the output of the aortic ventricle, breaking hit in her blood;
  • nonobstructive form - increases in myocardial mass is growing, not narrowing of the lumen of the aortic orifice.

believed that hypertrophic cardiomyopathy occurs when the defect is inherited by the shell of myocardial cells, disruption of normal patterns of some of the proteins needed for normal contraction of cardiomyocytes.

Hypertrophic cardiomyopathy develops most often in men progresses at a different rate.The process is accelerated if:

  • blood - as a result of stress or tumor - is supported by a high level of adrenaline or noradrenaline;
  • elevated insulin levels in the blood;
  • has thyroid disease;
  • further developed hypertension;
  • heavy gene mutation.

In hypertrophic cardiomyopathy, the following processes occur:

  • due to the fact that the left ventricular myocardium is growing inside the volume of the ventricle chamber decreases;
  • blood flowing to the heart, can not fit into the left ventricle, and it has to remain in the left atrium, which is gradually increasing;
  • in vessels coming from the left atrium (which is a small circle of blood circulation associated with light), congestion occurs;
  • myocardium increased demands for more oxygen, leading to ischemia;
  • thickened muscle mass worst carries momentum because of what appear arrhythmia.Violation of the right reduction of individual muscle fibers worsen the already impaired cardiac pump function.

Restrictive cardiomyopathy

so called myocardial damage when it is not increased, but its flexibility, ie the ability to stretch, much worse.This leads to the fact that the chambers of the heart can not accommodate the required volume of blood - there is stagnation in both the systemic circulation.

Restrictive cardiomyopathy is caused by heart:

  • tropical infection by viruses;
  • hemochromatosis;
  • sarcoidosis;
  • amilodoza;
  • scleroderma;
  • glycogenesis;
  • Fabry disease;
  • radiation damage to the heart;
  • taking certain medications.

Symptoms Pathology

Since each species has its own mechanism of disease development and progression, cardiomyopathy symptoms will vary.

Hypertrophic cardiomyopathy

If a person holds obstructive form of the disease (ie, reduced diameter of the hole, from which comes the aorta), develop signs of insufficient blood supply to the brain:

  • dizzy spells;
  • fainting;
  • shortness of breath;
  • weakness;
  • heart pain.

If there is a non-obstructive form, cardiomyopathy can be asymptomatic for a long time.Then may develop quite rapidly progressing:

  • shortness of breath, which initially accompanied only exercise, but later appears alone;
  • fatigue;
  • edema - initially only in the legs, then the above;
  • heaviness in the right upper quadrant;
  • heart attacks.

arrhythmia in this pathology are not always felt subjectively, but they are dangerous.Among male athletes, there are times when atrial fibrillation develops suddenly and is the cause of sudden death.

Dilated cardiomyopathy

The main feature of this disease is an enlargement of the heart chambers due to thinning of the myocardium.Therefore, there will be progressing heart failure:

  • fatigue;
  • dyspnea: first, when expressed, then already at the minimum physical effort;
  • pale skin;
  • swelling in the legs, then develops accumulation of fluid in the abdominal cavity and around the lungs (the pleural cavity);
  • increase in blood pressure - so the body tries to compensate for the lack of oxygen supply to the vital organs, including the brain (read about normal blood pressure);
  • skin under the nail plate acquires a bluish tint;
  • neck veins become visible;
  • pain in the heart, which does not disappear field taking nitroglycerin.

Similar symptoms have and alcoholic cardiomyopathy, which is essentially a dilated, arising as a result of the toxic action of ethanol and its decay product - acetaldehyde - on the heart muscle.Here, in the initial stage of the disease after taking alcohol the next day there:

  • weakness;
  • fatigue;
  • heartbeat;
  • pain in the heart that have piercing-aching in nature, lasting for several hours, not removed nitroglycerin;
  • feeling of disruption in the work of the heart.

progression of disease like symptoms are worse the next day after a drink, do not pass even if the person for several days or weeks refrains from alcohol.They can provoke any emotional and physical exercise.Subsequent progression of disease occurs in excess alcohol or within a few days thereafter.

Restrictive cardiomyopathy

leading mechanism of this kind of disease is an overload of the atria, which are beginning to take part of the ventricular function (elasticity last broken, and normally they can not be reduced).Rapidly progressive congestive heart failure:

  • shortness of breath;
  • swelling of the veins of the neck;
  • weakness - even with minimal physical exertion;
  • growing swelling;
  • progresses fluid effusion in the abdomen (ascites);
  • begins to "feel" the liver in the right upper quadrant: there appears a feeling of heaviness.

Arrhythmogenic right ventricular cardiomyopathy

The basis of the disease - the replacement of normal muscle cells that make up the myocardium of the right ventricle, is incapable of reduced fat or connective tissue.The disease is quite rare.Its appearance is associated with hereditary diseases, viruses, and poisoning by certain chemical agents.

pathology manifests itself in the adolescence as:

  • senses interruptions in the heart;
  • palpitations;
  • dizzy spells;
  • sporadically occurring faintness.

Dangers cardiomyopathy

Major, life-threatening complications 6. It:

  • heart failure, myocardial infarction
  • thromboembolic complications
  • arrhythmia
  • pulmonary edema
  • sudden cardiac death

Heart failure

Aswe see that all kinds of diseases lead to the development of heart failure.Most often it is a chronic congestive character associated with a decrease in the volume of blood ejected into the vessels, and internal organs anoxia.

In some cases, it may develop acute heart failure:

  1. systolic - when the heart can not properly cut and push enough blood.This is typical of dilated form of pathology;
  2. diastolic: ventricle is not filled with enough blood volume.This is typical of the type of restrictive cardiomyopathy.

Myocardial infarction

It is a condition when a larger or smaller portion of the myocardium dies due to lack of its blood supply.

This complication in the "pure form" is characteristic of hypertrophic cardiomyopathy, a thickened myocardium because it is difficult to provide sufficient oxygen.But such a pathology can occur with any other form of the disease if it is combined with an abnormal structure of coronary arteries supplying the heart, development of atherosclerosis or hypertension.

infarction should be suspected if:

  • there was a sharp and severe pain behind the breastbone;
  • she gives in his left hand (little finger of the hand), left shoulder blade or the left half of the jaw;
  • pain does not respond to nitroglycerin;
  • can be single vomiting, not relieves;
  • people pales;
  • covered with cold sweat;
  • breathing quickens.

In this case, you need to chew 1-2 tablets "Aspekard" ( "aspirin", "Cardio Magna") bed, open the window and call "ambulance."


blood stagnation, typical of the heart with myocardial damage, causes the activation of the blood coagulation system.So there are blood clots.Arrhythmias same, that is, unevenness of muscle contraction, in turn, increase the likelihood of "travel" of the thrombus from the cavity of the heart (this case is called a thrombus embolus) and their subsequent fixing in "suitable" vessel diameter.The body or part of it, fueled by that vessel, dies.

most dangerous embolism - is:

  • ischemic stroke - due to blockage of a blood clot from the brain of one of the arteries;
  • thromboembolism one or more branches of the pulmonary arteries, leading to a deterioration of the blood supply to various parts of the lung;
  • mesenteric thrombosis - when thromboembolism clog more or less large arterial branches supplying the bowel, leading to the death of its different areas;
  • thrombosis limb arteries, resulting in gangrene develops.


Violation normal sequential reduction of myocardial cells leads to oxygen starvation of tissues.If "randomly" ventricular cells begin to shrink, and this state of emergency is not correct, the person may die.

Pulmonary edema

When the left half of the heart develop congestion, extra volume of blood remains in the blood vessels going to the lungs.Over time, these blood vessels dilate and begin to pass the liquid part of the blood through its wall - into the lung tissue.

condition requires emergency medical care, and is manifested by shortness of breath, release a pink foam from the mouth, blue lips and fingertips, feeling short of breath and panic.


cardiomyopathy, even flowing no symptoms, can be suspected on:

  • radiograph, which shows an increase in the volume of the heart;
  • inspection data, during which the cardiologist listened to complaints, defines the boundaries of the heart, listens arrhythmias, deafness or muting its colors, some heart murmur;