Background

DefinitionDefinition NOTE: Ischemic CMP is similar than dilated CMP but by definition NOT a form of dil. CMP!

Primary myocardial disease

NOTE: Ischemic CMP is similar than dilated CMP but by definition NOT a form of dil. CMP!

Impaired systolic function

NOTE: Ischemic CMP is similar than dilated CMP but by definition NOT a form of dil. CMP!Dilatation

NOTE: Ischemic CMP is similar than dilated CMP but by definition NOT a form of dil. CMP!

CausesCauses

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!

Infiltrative disease (5%)

NOTE: Etiology is often not found because biopsie is not performed!

Associated ProblemsAssociated ProblemsAssociated Problems

Left heart failure Atrial fibrillation

Pulmonary hypertension Mitral regurgitation

Right heart failure Tricuspid regurgitation

Dyssynchrony Thromboembolism

Echofeatures

DiagnosisDiagnosisNOTE:Endstage ischemic CMP and dilated CMP look very similar!

Reduced LVFNOTE: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

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SeveritySeverity

Low output Reduced LVF, LVOT vel < 0.5m/sec

Atrial size Small atria

Diastolic function /filling pressure

Pseudonormal / restricitive pattern

Causes of Mitral regurgitation in CMPCauses 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 LVTenting

NOTE: MR increases mortality!additional volume overload of LV

Annulus

NOTE: MR increases mortality!additional volume overload of LV

Markers of poor prognosisMarkers of poor prognosis

Very severe LV-dysfunction Reduced RVF

Verly large LV MR

Elevated LVEFP

Specific Forms

Ischemic CMPmost common cause of heart failure

Tako Tsubo CMPstress 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 tachycardiareversible

Arrythmia mediated CMP ectopic beats > 17.000/24h

005 // Dilated Cardiomyopathy

2

LV Non—CompactionLV Non—Compaction

Characterized by prominent trabeculae and intertrabecular recessi

Associated with other cardiac abnormalities

Genetic disease, Risk of CMP, Family screening!

Associated with neuromuscular disorders

Chagas DiseaseChagas DiseaseChagas Disease

Trypanosoma cruzi Megaesophagus

Cardiac disease Megacolon

Most common form of CMP in Latin-AmericaMost common form of CMP in Latin-America

Right heart failure dominant regional + global dysfunctionRight heart failure dominant regional + global dysfunction

005 // Dilated Cardiomyopathy

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