Presentation
We present a challenging case of a young man presenting with ischemic-looking electrocardiogram (ECG) changes, fever, hypotension, and global left ventricular hypokinesis. [radcliffecardiology.com]
Presentation symptomatology can be nausea, dizziness, anxiety, dyspnea and palpitations. [bmcresnotes.biomedcentral.com]
Aneurysmal subarachnoid hemorrhage may induce Takotsubo cardiomyopathy that can present as an acute ST-elevation myocardial infarction. [link.springer.com]
Sinus tachycardia is frequently present, and non-specific ST-segment or T-wave changes as well as changes in P-wave morphology may well be present. [textbookofcardiology.org]
10.1016/S1885-5857(09)73549-2 Baltasar Laínez a, Marina Ureña a, Virginia Álvarez a, Román Lezaun a a Servicio de Cardiología, Hospital de Navarra, Pamplona, Navarra, Spain Article To the Editor, Tako-Tsubo cardiomyopathy (TC) is a syndrome of clinical presentation [revespcardiol.org]
Entire Body System
- Congestive Heart Failure
[…] the heart disease in beriberi (thiamine deficiency) is also associated with alcoholism. congestive cardiomyopathy a syndrome characterized by cardiac enlargement, especially of the left ventricle, myocardial dysfunction, and congestive heart failure. [medical-dictionary.thefreedictionary.com]
Congestive Heart Failure This is a common feature of all late stage cardiomyopathies when the muscles of the heart become too weak to pump enough blood to the body for normal function. [childrenscardiomyopathy.org]
[…] muscle) Cardiomyopathy associated with another disorder Cardiomyopathy, primary (heart condition) Congestive heart failure (chf) with cardiomyopathy Congestive heart failure due to cardiomyopathy Primary cardiomyopathy Secondary cardiomyopathy Tachycardia [icd10data.com]
Vitamin D deficiency and cardiac failure in infancy. J R Soc Med 2004 ; 97 : 238 – 239. 7. Gillor, A, Groneck, P, Kaiser, J, Schmitz-Stolbrink, A. Congestive heart failure in rickets caused by vitamin D deficiency. [cambridge.org]
In some individuals, all four chambers of the heart may be affected. Symptoms of congestive heart failure may depend upon an affected child’s age and other factors. [rarediseases.org]
- Anemia
Blood tests may be helpful in screening for anemia, abnormalities in electrolytes, and kidney and liver function. Other blood tests and lab work may be ordered depending upon the clinical situation. [emedicinehealth.com]
Other known causes are frequent use of certain drugs, excessive alcohol use, sensitivity to chemicals and toxins, infection due to HIV, build up of proteins in the heart muscle (amyloidosis), severe anemia or nutritional deficiencies and rare complications [childrenscardiomyopathy.org]
- Poor Feeding
Initial symptoms of dilated cardiomyopathy in infants and children may include irritability, a persistent cough, shortness of breath, and poor feeding resulting in the failure to gain weight at the expected rate (failure to thrive). [rarediseases.org]
Respiratoric
- Pleural Effusion
Computed tomography of chest (Figure 2 ) revealed bilateral peribronchovascular airspace consolidation, ground-glass opacity with interlobular septal thickening and small bilateral pleural effusions. [bmcresnotes.biomedcentral.com]
Pope A study of the frequency of pericardial and pleural effusions in scleroderma Br J Rheumatol, 37 (1998), pp. 1320-1323 [9.] G.S. Uhl, G.M. Koppes Pericardial tamponade in systemic sclerosis (scleroderma) Br Heart J, 42 (1979), pp. 345-348 [10.] [reumatologiaclinica.org]
Common abnormalities seen on the chest radiograph include cardiomegaly, interstitial edema, pleural effusion(s), and evidence of previous sternotomy (sternal wires). [clevelandclinicmeded.com]
Gastrointestinal
- Failure to Thrive
Initial symptoms of dilated cardiomyopathy in infants and children may include irritability, a persistent cough, shortness of breath, and poor feeding resulting in the failure to gain weight at the expected rate (failure to thrive). [rarediseases.org]
Clinical Presentation and Diagnosis Age of onset may be highly variable, with cyanosis, failure to thrive or dysmorphic features described in the neonatal period, to adult patients presenting with LV failure or ventricular arrhythmia. [textbookofcardiology.org]
Liver, Gall & Pancreas
- Hepatomegaly
Additional symptoms may include fluid collection in the abdomen (ascites) and feet due to accumulation of fluid, congestion of the lungs, and an abnormally large liver (hepatomegaly). [rarediseases.org]
Cardiovascular
- Heart Disease
diseases; 2º cardiomyopathies may be linked to Adriamycin, alcohol, catecholamines–pheochromocytoma, cobalt intoxication, diphtheria, beriberi heart disease, and various chemicals and drugs. [medical-dictionary.thefreedictionary.com]
[…] artery disease or heart attack cause the disease. [heart.org]
Ischemic heart disease is a disease classified elsewhere. Similarly, hypertension is a disease classified elsewhere. [hcpro.com]
Differential diagnosis Coronary artery disease. Mitral valve disease. Athlete's heart: prolonged isometric training may produce heart changes resembling some features of hypertrophic cardiomyopathy. Amyloidosis. [patient.info]
Atrial fibrillation is a common manifestation of hypertensive heart disease. Hypertensive heart disease is the leading identifiable cause of heart failure in older women. [clevelandclinicmeded.com]
- Tachycardia
Dose-dependent tachycardia, hypertension along with increased arousal is the first physiological response to cocaine use. [bmcresnotes.biomedcentral.com]
The patient’s heart rate increased to 130bpm immediately after the intubation, with telemetry showing sinus tachycardia. An ECG was performed within one minute after intubation (see Figure 1 ). [radcliffecardiology.com]
Tachycardia-induced cardiomyopathy Persistently high heart rates (above 110 beats per minute), such as in sustained ventricular tachycardia, or associated with atrial fibrillation, results in heart failure when left untreated. [textbookofcardiology.org]
With prolonged arrhythmias, the heartbeat may become either too fast (tachycardia) or too slow (bradycardia) and can occur in either the heart ventricles or atrial. [childrenscardiomyopathy.org]
Tachycardia-induced cardiomyopathy Pregnancy Peripartum cardiomyopathy © 2003 The Cleveland Clinic Foundation. [clevelandclinicmeded.com]
- Cardiomegaly
Cardiomegaly is usually considered a requisite for the diagnosis of dilated cardiomyopathy. [8] The mean heart weight is about 600 g. [9] Some patients with dilated cardiomyopathy have very little cardiac enlargement, and the diagnosis must be made on [emedicine.medscape.com]
Cardiomegaly may be suspected on chest radiography, and the electrocardiogram shows non-specific abnormalities of the ST-segment and T-waves. Conduction defects may also occur. [textbookofcardiology.org]
Common abnormalities seen on the chest radiograph include cardiomegaly, interstitial edema, pleural effusion(s), and evidence of previous sternotomy (sternal wires). [clevelandclinicmeded.com]
- Gallop Rhythm
Examination should focus on whether the heart is palpably dilated, the presence of murmurs, and additional heart sounds (gallops). [clevelandclinicmeded.com]
An important feature of the physical examination is a gallop rhythm of S3 and S4. S3 and S4 may fuse in tachycardic patients with new onset of heart failure. [textbookofcardiology.org]
- Heart Murmur
Is there a family history of disabling heart disease before 50 years of age? Is there a family history of conditions known to increase cardiac risk (e.g., dilated or hypertrophic cardiomyopathy)? Evaluate for heart murmur. [aafp.org]
Musculoskeletal
- Muscle Weakness
Congestive Heart Failure This is a common feature of all late stage cardiomyopathies when the muscles of the heart become too weak to pump enough blood to the body for normal function. [childrenscardiomyopathy.org]
Workup
Initial laboratory workup at admission was insignificant except for elevated brain nautriuretic peptide of 894 ng/L and positive urine toxicology screen for cocaine. [bmcresnotes.biomedcentral.com]
The term "idiopathic" means that the physician cannot determine the cause of the cardiomyopathy despite extensive workup. If the physician can determine the cause, then by definition it's secondary cardiomyopathy. [hcpro.com]
Blocks
- Incomplete Right Bundle Branch Block
A previous ECG (two years ago) showed incomplete right bundle branch block morphology but no other abnormality. [radcliffecardiology.com]
T Wave
- T Wave Inversion
[…] with no history of CAD, and frequent T-wave inversion. [aafp.org]
These may include electrocardiogram (ECG) changes of QT prolongation and T wave inversion, elevated biochemical markers of myocardial damage and heart failure, and decreased left ventricular function [ 1 ]-[ 3 ]. [link.springer.com]
Electrocardiographic diagnostic criteria for HCM in first-degree relatives of index cases with HCM : Major: Left ventricular hypertrophy and repolarization changes T-wave inversion in leads I and aVL (=3mm) (with QRS–T wave axis difference =30°), V3–V6 [textbookofcardiology.org]
Hypertrophy
- Left Ventricular Hypertrophy
Beware of encoders What about a patient with left ventricular hypertrophy due to increased work caused by aortic stenosis? Physicians refer to this as valvular heart disease. In their minds, it's a cardiomyopathy. [hcpro.com]
[…] volume, normal left ventricle wall thickness, normal systolic function, and impaired ventricular filling. 1 The ECG typically reveals decreased voltage despite signs of left ventricular hypertrophy. [aafp.org]
Typical echocardiographic features include a high left ventricular mass index, increased left ventricular mass and left ventricular dysfunction [ 8 ]. [bmcresnotes.biomedcentral.com]
Echocardiography shows left ventricular dilatation with hypokinesis, right ventricular enlargement and hypertrophy and possibly left ventricular aneurysm formation. [textbookofcardiology.org]
Important complications of fibrosis include left ventricular hypertrophy, as well as systolic and diastolic dysfunction of both ventricles. [reumatologiaclinica.org]
Pleura
- Pleural Effusion
Computed tomography of chest (Figure 2 ) revealed bilateral peribronchovascular airspace consolidation, ground-glass opacity with interlobular septal thickening and small bilateral pleural effusions. [bmcresnotes.biomedcentral.com]
Pope A study of the frequency of pericardial and pleural effusions in scleroderma Br J Rheumatol, 37 (1998), pp. 1320-1323 [9.] G.S. Uhl, G.M. Koppes Pericardial tamponade in systemic sclerosis (scleroderma) Br Heart J, 42 (1979), pp. 345-348 [10.] [reumatologiaclinica.org]
Common abnormalities seen on the chest radiograph include cardiomegaly, interstitial edema, pleural effusion(s), and evidence of previous sternotomy (sternal wires). [clevelandclinicmeded.com]
Treatment
Some people will not need any treatment. Treatment of secondary cardiomyopathy may involve treating the underlying condition. [mydr.com.au]
Treatment for dilated cardiomyopathy is directed at the underlying disease. [aafp.org]
[ edit ] Treatment may include suggestion of lifestyle changes to better manage the condition. [en.wikipedia.org]
Adequate antihypertensive treatment can regress left ventricular mass. In patients with aortic stenosis, ultimate treatment is valvular replacement to relief the systolic overload of the ventricle. [textbookofcardiology.org]
Non-invasive testing should be performed after several months to re-evaluate the treatment response. [bmcresnotes.biomedcentral.com]
Prognosis
These patients had a poor short term prognosis (p < 0.001). [ncbi.nlm.nih.gov]
[…] indicated in patients with LVEF The prognosis of LVNC has currently not yet been defined. [textbookofcardiology.org]
Identification of these areas and restoration of their perfusion through revascularization might improve the ejection fraction and long-term prognosis. [clevelandclinicmeded.com]
Apical and mid-ventricular transient left ventricular dysfunction syndrome (Tako-tsubo cardiomyopathy): frequency, mechanisms, and prognosis. Chest. 2007;132: 809-16. Medline 5. [revespcardiol.org]
Prognosis Dilated cardiomyopathy is associated with a survival rate of less than 50% at 10 years. [emedicine.medscape.com]
Etiology
[…] of abnormal substances, as may occur in amyloidosis, hemochromatosis, and other disorders. primary cardiomyopathy that in which the basic pathologic process involves the myocardium itself and not other cardiac structures; the condition is of unknown etiology [medical-dictionary.thefreedictionary.com]
Cardiomyopathies may be classified as either primary or secondary, on the basis of etiology, or on the pathophysiology of the lesion: hypertrophic, dilated, or restrictive. [icd10data.com]
Cardiomyopathies may be classified as either primary or secondary, on the basis of etiology, or on the pathophysiology of the lesion: hypertrophic, dilated, or restrictive. [ NCIT : C34830 ] Synonyms: extrinsic cardiomyopathy, [X]Cardiomyopathy in other [ebi.ac.uk]
Etiology The causes of cardiomyopathies are varied ( Table 2 ). 1 Dilated cardiomyopathy in adults is most commonly caused by CAD (ischemic cardiomyopathy) and hypertension, although viral myocarditis, valvular disease, and genetic predisposition may [aafp.org]
Recurrence of the disease in subsequent pregnancies is noted, and makes the previously mentioned etiologies hard to explain. [textbookofcardiology.org]
Epidemiology
The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003;348:1546-1554. [ Links ] 4. Brun-Buisson C, Meshaka P, Pinton P, Vallet B. EPISEPSIS Study Group. [scielo.org.mx]
Epidemiology of dilated cardiomyopathy. A prospective post-mortem study of 5252 necropsies. The Heart Muscle Disease Study Group. Eur Heart J. 1997 Jan. 18(1):117-23. [Medline]. Matsumura Y, Takata J, Kitaoka H, Kubo T, Baba Y, Hoshikawa E, et al. [emedicine.medscape.com]
Epidemiology In contrast to coronary heart disease having a higher incidence in the elderly, cardiomyopathies can occur at younger ages. [patient.info]
Vitamin-D concentrations, cardiovascular risk and events - a review of epidemiological evidence. Reviews in Endocrine and Metabolic Disorders, Vol. 18, Issue. 2, p. 259. [cambridge.org]
Pathophysiology
Cardiomyopathies may be classified as either primary or secondary, on the basis of etiology, or on the pathophysiology of the lesion: hypertrophic, dilated, or restrictive. [icd10data.com]
Cardiomyopathies may be classified as either primary or secondary, on the basis of etiology, or on the pathophysiology of the lesion: hypertrophic, dilated, or restrictive. [ NCIT : C34830 ] Synonyms: extrinsic cardiomyopathy, [X]Cardiomyopathy in other [ebi.ac.uk]
PubMed View Article Google Scholar Abraham JR, Butany J, Leong S, Luk A, Phillips K, Soor GS: Cocaine cardiotoxicity a review of the pathophysiology, pathology, and treatment options. Am J Cardiovasc Drugs. 2009, 9 (3): 177-196. 10.1007/BF03256574. [bmcresnotes.biomedcentral.com]
Additionally, arrhythmias and chest pain may be present. [10] The pathophysiology of cardiomyopathies is better understood at the cellular level with advances in molecular techniques. [en.wikipedia.org]
However, they don't always evaluate pathophysiology. Without this evaluation, documentation of CMP can be deceiving. When coders see this documentation, they report ICD-9-CM code 425.4 for the CMP even when the patient may have something else. [hcpro.com]
Prevention
Global Consensus Recommendations on Prevention and Management of Nutritional Rickets. J Clin Endcorinol Metab, February 2016, 101 (2):394-415 3. [imj.ie]
Is It Possible to Prevent Cardiomyopathy? Cardiomyopathy is a term that describes the end result of many diseases and illnesses. [emedicinehealth.com]
Vitamin D and cardiovascular disease prevention. Nature Reviews Cardiology, Vol. 13, Issue. 7, p. 404. CrossRef Google Scholar Reid, Ian R 2016. What diseases are causally linked to vitamin D deficiency?. [cambridge.org]
Prevention In many cases, cardiomyopathy cannot be prevented. However, there are some types of cardiomyopathy that can be avoided, such as those that are caused by excessive alcohol or drug use. [mydr.com.au]
Specific inhibitors and promoters of calcium action in the excitation-contraction coupling of heart muscle and their role in the prevention or production of myocardial lesions. In Calcium and the Heart, ed. [books.google.es]