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Course: Health and medicine > Unit 3
Lesson 9: Cardiomyopathy- What is cardiomyopathy?
- Cardiomyopathy signs and symptoms
- Dilated cardiomyopathy: Pathophysiology and diagnosis
- Hypertrophic cardiomyopathy: Pathophysiology and diagnosis
- Restrictive cardiomyopathy: Pathophysiology and diagnosis
- Cardiomyopathy treatment
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Cardiomyopathy treatment
Created by Matthew McPheeters.
Want to join the conversation?
- How does alcohol destroy cardimyocytes during septal ablation?(5 votes)
- In the procedure, a small volume of ethanol is injected directly into an artery supplying the septum (found under fluoroscopic guidance). The ethanol disrupts cell membranes, causing rupture of the cells, and the effect is an infarction (hopefully) limited to the septum. Ideally, enough of the septum dies that left ventricular outflow is increased and patient symptoms are improved.(2 votes)
- What about stress-induced cardiomyopathy? Is it reversible?
And why wasn't stress-induced cardiomyopathy mentioned in any of the videos?(2 votes)- Crash course on SIC- Stress-induced cardiomyopathy(SIC) is a weakening of the left ventricle, which is the main chamber through which the heart pumps blood. This usually happens after an extremely stressful situation, such as the loss of a loved one or a sudden illness. The features of this disease are:
-Chest pain and shortness of breath after severe stress (emotional or physical)
-Electrocardiogram abnormalities that mimic those of a heart attack
-No evidence of coronary artery obstruction
-Movement abnormalities in the left ventricle
-Ballooning of the left ventricle
-Recovery within a month
SIC has symptoms that can be mistaken for a heart attack, and most physicians look in scans for an abnormal bulging of the heart. SIC is treatable, and many people with this condition recover after about a month or two: patients with this illness usually have to take beta blockers and ACE inhibitors(standard heart failure pills). Psychological treatment may also be necessary to alleviate people of the stressful situation they are going through. Although death by this condition is rare, approximately 20% of people with SIC have heart failure occur. If you want a more in-depth explanation, I'd recommend going to the American Heart Association website.
Hope this helps!
Source: https://www.health.harvard.edu/heart-health/takotsubo-cardiomyopathy-broken-heart-syndrome(2 votes)
Video transcript
- [Voiceover] Let's look at
the treatment of cardiomyopathy based on the physiology of the disease. To do so, I'm gonna just draw here a simplified diagram of the cardiac system. I want you to think of
the cardiovascular system as the heart, as a series
of two pumps that are separated by the lungs,
up here, and the body. Kinda think of the body as two tanks. Over here, on the left side, we'll have blood filled in this tank. This blood enters into the right heart and the heart pumps
this blood to the lungs. In the lungs, the blood is oxygenated. It returns to the left
heart where it is then pumped back to the body. If you think about this
second tank, the heart has to pump this blood enough to
get into this normal range. These dotted lines, here,
are gonna represent a normal range in order to get that blood adequately out to the
body where it is used. Here, we'll kinda demonstrate
this mixing of blood with a purple color, used
by the body's organs, like the brain, and the intestines, and the muscles and everything. That blood now is de-oxygenated and returns back to the heart, here. That's how I want you to
kinda think of a normal flow of blood in the cardiac system. In cardiomyopathy, you have
a failure of this system. When it fails, the heart is not able to adequately pump blood out. This, here, is decreased. When you don't get an
adequate outflow of blood, this tank isn't filled
to a level that's able to adequately perfuse the body. Also, over here, if the blood
isn't coming out of the heart, cuz you have a heart failure,
it's gonna get backed up in this tank, and this tank
is gonna be overflowing. If you think of
cardiomyopathy in this way, you can see three areas in which
the disease can be treated. In the center, here, the
main cause of cardiomyopathy is that you have a pump failure. Over here on the left, you
have this backup of blood flow. Over here on the right, you
have a decreased outflow. If you think about it this
way, you can see the three major targets of how
cardiomyopathy can be treated. For each of these three
mechanisms, I'm gonna talk about a few different treatment options and what types of
cardiomyopathy they pertain to. I'm gonna just write in the
types of cardiomyopathy, here. I'll use DCM to abbreviate
for dilated cardiomyopathy, and RCM for restrictive cardiomyopathy, and HCM for hypertrophic cardiomyopathy. Let's start with treatments
that address the backup of fluid caused by this heart failure. The first thing that
someone with cardiomyopathy can do are lifestyle changes,
such as a low-salt diet. Salt is made up of
sodium and sodium is what determines the amount of
fluid the body retains. If you have a low-salt
diet, the body will try and get rid of this backed-up fluid. This is a primary treatment for both dilated cardiomyopathy and
restrictive cardiomyopathy. If a low-salt diet is not sufficient, diuretics can be added
to the treatment regimen. Diuretics have the same
effect, although they are more efficient at decreasing
this backed-up blood flow. So, that's also used in
dilated cardiomyopathy and restrictive cardiomyopathy. The last medication I wanna mention, here, for treating the backup
are ACE inhibitors. They are also used in
dilated cardiomyopathy and restrictive cardiomyopathy. Notice that none of
these treatments are used in hypertrophic cardiomyopathy, and that's because hypertrophic cardiomyopathy only results in symptoms intermittently. Individuals with
hypertrophic cardiomyopathy don't typically have
these signs and symptoms of fluid backup, so that mechanism does not need to be treated. Let's move on to the pump
failure and treatments that directly address what's
going on in the heart. The first one to mention are two types of medications that have similar effects. Those are beta blockers and
calcium channel blockers, which I'll abbreviate CCB. These medications are used in
both dilated cardiomyopathy and hypertrophic cardiomyopathy, but they're used for different reasons. In dilated cardiomyopathy, beta blockers and calcium channel blockers
decrease the oxygen demand of the heart, which can decrease some of the symptoms when
the heart is overworked. However, in hypertrophic cardiomyopathy, these medications treat the
disease by a different means. These medications also
slow down the heart rate. In hypertrophic cardiomyopathy,
this is important because they decrease heart
rate, increases the time in which the heart is spent in diastole, or the filling phase. Then, when it contracts,
there's an increased outflow. The next medication, here, is Digoxin. Digoxin isn't used all
that frequently, but it can be used for dilated cardiomyopathy. What it does is it increases
the contractile strength of the heart muscle to
overcome this pump failure. It's really only used in
dilated cardiomyopathy. These are the medications that are used to treat the pump
failure, but there's also a few devices or
procedures that can be done to treat the pump failure
in cardiomyopathy. The first one I wanna
mention is a pacemaker. A pacemaker is a device
that is actually implanted into the heart to make sure
that the heart beats regularly. In dilated cardiomyopathy and
restrictive cardiomyopathy, the disease can become so severe that the conduction pathways
that cause the heart to beat regularly can
become dysfunctional. A pacemaker can be used to improve the heart's ability to
beat on a regular basis. That's used to treat
dilated cardiomyopathy and restrictive cardiomyopathy. The next treatment of the pump failure is something known as septal reduction. Septal reduction is only
used for hypertrophic cardiomyopathy because
hypertrophic cardiomyopathy is caused by this asymmetric enlargement of the ventricular septum. If you reduce the size of the septum, you decrease the severity of disease. A septal reduction can actually be done in two different ways. It can be done by
actually injecting alcohol into the septum, which
causes the muscle cells to reduce in size. Or, it can be done surgically
through a procedure known as a septal myomectomy. The last treatment for pump
failure is a transplant. A heart transplant is
really a last-ditch effort to treat any of the
forms of cardiomyopathy. Now, let's move on to this
last target of treatment, which is the decreased outflow. There's really only one
medication that's used on a regular basis to
specifically treat this mechanism. That, we actually already mentioned over in the backup, is ACE inhibitors. What ACE inhibitors do
is they cause dilation of the arterials, here, which
decreases the resistance in the arterial system, of which the heart has to pump against. For the same contraction strength, you can get an increased outflow from the heart. This is used to treat, once again, dilated cardiomyopathy and
restrictive cardiomyopathy. This is just a brief
overview of the treatments of the different types of cardiomyopathy. If you can remember
this simplified diagram of the cardiovascular system
and how cardiomyopathy causes a pump failure with
subsequent backup of fluids, as well as a decreased
outflow, you can remember that there are three main targets of the treatments for cardiomyopathy. They vary somewhat depending
on the specific type of cardiomyopathy, whether
it be dilated cardiomyopathy, restrictive cardiomyopathy or
hypertrophic cardiomyopathy.