Cardiomyopathy (Pathophysiology (Primary Cardiomyopathy (Secondary…
Cardiomyopathy is a disease of the heart muscle. The heart’s role is to pump blood around the body to oxygenate and supply cells with nutrients. Cardiomyopathy isn’t a single condition but a group of conditions that affect the structure of the heart and reduces its ability to pump blood. In cardiomyopathy, the heart become enlarged, thick or rigid while in rarer case the heart muscle is actually replaced with scar tissue.Cardiomyopathy can be split into two different types, primary and secondary.
Primary cardiomyopathy is when there is no other cardiac condition that can affect the heart in making it weaker. In most cases it is a genetic disease that is passed on in the family.
Secondary cardiomyopathy is caused by another medical issue involving the heart. Some of these conditions include; hypertension, valvular disease, congenital heart disease and coronary artery disease. Some of these diseases can be treated which can affect the muscle tissue of the heart before coming weaker and subjected to cardiomyopathy. The treatment in secondary cardiomyopathy is to first identify the correct medical condition(s) that are responsible for the condition.
Secondary cardiomyopathy can also be broken down into two subcategories ischemic and non-ischemic depending if coronary artery disease (CAD) is the major cause in the disease. Ischemic cardiomyopathy is caused by CAD as there are blockages in the arteries, ischemic meaning the body is not getting enough blood and this is due because of the blockages in the arteries. Non- ischemic cardiomyopathy is caused by lifestyle factors or are even inherited from the family. These types are again broken down into 4 subclasses and are non-ischemic because of the fact these 4 types are not related to CAD.
Sub-classes : 1. Dilated Cardiomyopathy.
- Hypertrophy Cardiomyopathy.
- Restrictive Cardiomyopathy.
- Ischemic cardiomyopathy
While the treatment of cardiomyopathy depends on the specific cause, the goal of treatment is to maximise cardiac output and maintain ejection fraction. This is all to prevent any further damage to the heart muscle. Beginning treatment with administering oxygen, acquiring a 12-lead ECG, initiating continuous pulse oximetry and obtaining an intravenous access. The intravenous line gives a quick access to deliver drugs to the heart as its connected straight to the blood stream. If there is a potential for cardiac arrest, defibrillator pads will also be ready on the patient in case of such emergencies. Obtaining a thorough history check of the patient is essential as well because this helps in determining the aetiology of cardiomyopathy. Next, transportation to the hospital for tests and evaluating is needed for the survival of the patient.
Pacemakers can be installed to provide coordinate and stable impulse to the heart if the cardiomyopathy has developed from an electrical problem.
Serve cardiomyopathies which cannot be controlled with pacemakers or medication other surgical interventions such as heart transplants maybe consider as a final option.
Diagnosing Cardiomyopathy is particular tricky when out in the field. A 12 lead ECG as well as history taking should be conducted to show a more accurate view of the heart and to know more about the patient to see if this has happened before. When evaluating the ECG, a patient can either show a normal reading or an abnormal reading but if the patient is complaining about the heart the most important thing to do is get them to hospital. If suffering from a cardiac condition the hospital will conduct further testing to evaluate the patient.
Further testing in hospital include;
• Blood test
• Chest X rays
• Stress test
• Cardiac catheterization
Certain diseases, conditions and factors can raise your chances of cardiomyopathy. A lot of these risk factors are influenced by our day to day life and this include;
• Sedentary lifestyle
Other risk factors are developed over time and left untreated can develop into cardiomyopathy, these include
• Valvular disease
• Congenital heart disease
• Coronary artery disease
While other risk factor are passed down through the family and they are known hereditary heart diseases.
Many people with cardiomyopathy either have none or minimal symptoms. The presentation of the disease worsens over time as the function of the heart start to dysfunction. These symptoms can occur at any age and gender with many lifestyle factors being influenced by them.
• Shortness of breath
• Oedema of the feet and legs
• Weight gain
• Blood clots
• Arrhythmias (irregular heartbeats)
• Chest pain
Treatment for Cardiomyopathy is essentially the same as treating a patient with Chronic Heart Failure, a number of drug options for Cardiomyopathy are given but not limited to the following:-
• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin II receptor blockers (ARBs)
• Cardiac glycosides
Cardiac glycosides are the oldest way to treat heart failure, they are still used despite advances in other drugs that are more effective for when the ventricles dysfunctions. Cardiac glycosides are an organic compound that act on the contractile force of the heart. Cardiac glycosides also work better when they are used with diuretics and vasodilators.
Beta-blockers have 4 main tasks for people with any heart condition; they are to improve the hearts ability to relax, decrease the production of harmful substances, slow heart rate, and overtime improve the hearts ability to pump blood.
The use of ACE inhibitors and ARBs have been shown to decrease the mortality rate because of the affect it has on the left ventricle when it is dysfunction. The levels of plasma renin increase while aldosterone is reduced, this is to regulate the pressure of the blood, urine output and thirst.
Diuretics are also known as the ‘Water Pills’ as they help the body rid of any unneeded water and salts through the urine. The heart can now pump blood easier as the urine has decreased the level of the unneeded salt and water. Vasodilators are used to treat or prevent hypertension as this medicine is used to open up blood vessels making the flow of blood easier.
People of all types of races, genders and age can be affected by cardiomyopathy. Although the cause of Cardiomyopathy are varied with each individual depending on their family history and lifestyle choices. The most common group of people however are those who suffer from a pre-existing heart disease, if left untreated the individuals are more likely to develop cardiomyopathy.