Cardiomyopathy | Cardiology System Blueprint

Cardiomyopathy (PEARLS)

The NCCPA™ PANCE Cardiology System Content Blueprint includes 3 different types of cardiomyopathy

Types of cardiomyopathy

Dilated cardiomyopathy: ventricles enlarge and weaken - inherited in about one-third of cases, may also result from alcohol, heavy metals, coronary artery disease, cocaine use, and viral infections.
Hypertrophic cardiomyopathy: the heart muscle enlarges and thickens - inherited autosomal dominant -
Restrictive cardiomyopathy: ventricle stiffens - may be caused by amyloidosis, hemochromatosis, and some cancer treatments
Arrhythmogenic right ventricular dysplasia (ARVD): fatty replacement of myocardium - genetic defect
Takotsubo cardiomyopathy (broken heart syndrome): non-ischemic cardiomyopathy in which there is a sudden temporary weakening of the muscular portion of the heart -extreme emotional or physical stress

Impaired Systolic Function
Dilated Cardiomyopathy	Dilated cardiomyopathy is the most common type (95%) of cardiomyopathy and is a condition in which an index event or process (such as an MI) damages the myocardium, weakening the heart muscle resulting in reduced strength of ventricular contraction, and dilation of the left ventricle. Reduced contraction strength, large heart Etiology: caused by Ischemia (CAD, MI, arrhythmia), genetics, excess alcohol, postpartum, chemotherapy, endocrine disorders, viral infections, cocaine use, heavy metals Inherited in 1/3 of cases Physical exam: Dyspnea, S3 gallop, rales, jugular venous distention - systolic heart failure Treatment: Abstain from alcohol Medications: ACE inhibitors, diuretics
Impaired Diastolic Function
Hypertrophic Obstructive Cardiomyopathy (HOCM)	Hypertrophic portion of septum - LV outflow tract is narrowed - during systole and obstruction worsened with increased contractility Presentation: Young athlete with a positive family history has sudden death or syncopal episode Inherited autosomal dominant Presents in early adulthood Not to be confused with hypertrophy of elite athlete Screen family members Physical Exam: Sustained PMI, bifid pulse, S4 gallop Murmur: High pitched mid-systolic murmur at LLSB. Increased with Valsalva and standing (less blood in the chamber). Decreased with squatting (more blood in the chamber) Increased with Valsalva or standing Treatment: Refrain from vigorous physical activity Medical: Beta-blockers or calcium channel blockers Surgical: Surgical or alcohol ablation of hypertrophied septum and defibrillator insertion
Restrictive Cardiomyopathy	Right heart failure with a history of an infiltrative process Etiology: Amyloidosis, sarcoidosis, hemochromatosis, scleroderma, fibrosis, and cancer Physical Exam: Pulmonary HTN present Normal ejection fraction, normal heart size, large atria, normal left ventricular wall, early diastolic filling Treatment: Non-specific. Diuretics, ACE inhibitors, Calcium channel blockers