Cardiomiopatia dilatativa

• A treia cauza de insuficienta cardiaca

• Dilatarea ventriculara
• Disfunctie contractila
• +- ventriculul drept
• Dilated cardiomyopathy is a progressive disease
of heart muscle that is characterized by
ventricular chamber enlargement and contractile
dysfunction. The right ventricle may also be
dilated and dysfunctional. Dilated
cardiomyopathy is the third most common cause
of heart failure and the most frequent reason for
heart transplantation.
• Dilated cardiomyopathy is 1 of the 3 traditional
classes of cardiomyopathy, along with
hypertrophic and restrictive cardiomyopathy.
However, the classification of cardiomyopathies
continues to evolve, based on the rapid evolution
of molecular genetics as well as the introduction
of recently described diseases.
• Cardiomyopathy is a complex disease process that can
affect the heart of a person of any age, but it is
especially important as a cause of morbidity and
mortality among the world's aging population. It is the
most common diagnosis in persons receiving
supplemental medical financial assistance via the US
Medicare program.
• Nonpharmacologic interventions are the basis of heart
failure therapy. Instruction on a sodium diet restricted
to 2 g/day is very important and can often eliminate
the need for diuretics or permit the use of reduced
dosages. Fluid restriction is complementary to a low-
sodium diet. Patients may be enrolled in cardiac
rehabilitation involving aerobic exercise.
 Simptome
• Fatigabilitate
• Dispnee, tuse
• Ortopnee, dispnee paroxistica nocturna
• Edem, staza
• Tahicardie
• Tahipnee
• Hiper/ hipotensiune
• Signs of hypoxia (eg, cyanosis, clubbing)
• Jugular venous distension (JVD)
• Pulmonary edema (crackles and/or wheezes)
• S 3 gallop
• Enlarged liver
• Ascites or peripheral edema
• Complete blood count
• Comprehensive metabolic panel
• Thyroid function tests
• Cardiac biomarkers
• B-type natriuretic peptide assay
• Chest radiography
• Echocardiography
• Cardiac magnetic resonance imaging (MRI)
• Electrocardiography (ECG)
• In many cases of cardiomyopathy, endomyocardial biopsy is class II (uncertain
efficacy and may be controversial) or class III (generally not indicated). Class II
indications for endomyocardial biopsy include the following:
• Recent onset of rapidly deteriorating cardiac function
• Patients receiving chemotherapy with doxorubicin
• Patients with systemic diseases with possible cardiac involvement (eg,
hemochromatosis, sarcoidosis, amyloidosis, Löffler endocarditis, endomyocardial
fibroelastosis)
• Treatment of dilated cardiomyopathy is essentially the same as
treatment of chronic heart failure (CHF). Some therapeutic
interventions treat symptoms, whereas others treat factors that
affect survival.
• Drug classes used include the following:
• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin II receptor blockers (ARBs)
• Beta-blockers
• Aldosterone antagonists
• Cardiac glycosides
• Diuretics
• Vasodilators
• Antiarrhythmics
• Human B-type natriuretic peptide
• Inotropic agents
• Neprilysin inhibitor
• Nitrates
• Surgical options for patients with disease
refractory to medical therapy include the
following:
• Temporary mechanical circulatory support
• Left ventricular assist devices
• Cardiac resynchronization therapy (biventricular
pacing)
• Automatic implantable cardioverter-defibrillators
• Ventricular restoration surgery
• Heart transplantation