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Heart Failure & Cardiomyopathy

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38 views32 pages

Heart Failure & Cardiomyopathy

Uploaded by

huehuemerchant
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Heart failure and cardiomyopathy

II MBBS

Dr. Maitrayee Roy MD FRCPath

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Overview of circulation

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What is “ejection fraction”?

• Ejection fraction (EF) is a measurement, expressed as


a percentage, of how much blood the left ventricle
pumps out with each contraction.

• E.g.: An ejection fraction of 60% means that 60% of


the total amount of blood in the left ventricle is
pushed out with each heartbeat.

• A normal heart’s ejection fraction is between 55 and


70 percent

3
Tests to measure “ejection fraction”?

• Echocardiography – the most common test used to


measure ejection fraction.
• Cardiac catheterization
• CT scan
• MRI
• Cardiac PET-CT nuclear medicine scan

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Heart failure

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Definition
• A complex clinical syndrome that can result from any
structural or functional cardiac disorder that impairs the
ability of the ventricle to fill with or eject blood at a rate
sufficient to meet organ perfusion & metabolic demands
of the tissues (or can do so only at an elevated filling
pressure).

• It is the common end stage of many forms of chronic heart


disease (e.g. valve disease or hypertension).

• However, acute hemodynamic stresses, like fluid overload


or myocardial infarction, can also precipitate sudden CCF.
7
Physiologic mechanisms that maintain
arterial pressure and organ perfusion

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Physiologic mechanisms that maintain
arterial pressure and organ perfusion

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Heart failure happens when these adaptive
mechanisms are overwhelmed

• Heart failure can result from progressive deterioration of


myocardial contractile function → reduced ejection
fraction i.e. reduced volume of blood ejected from left
ventricle during systole → called systolic failure → Left
heart failure

• Heart failure can also result from an inability of the right


heart chamber to expand due to stiff ventricular wall →
fill insufficiently during diastole → diastolic failure →
right heart failure
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Etiology of heart failure
Left heart failure Right heart failure
• Ischemic heart disease • Most commonly secondary
including myocardial to left heart failure
infarction • Isolated RHF occurs
• Hypertension secondary to pulmonary
pathology (e.g. COPD
• Aortic and mitral
induced cor pulmonale,
valvular diseases
pulmonary embolism,
• Primary myocardial chronic pulmonary
diseases like dilated hypertension)
cardiomyopathy • Right ventricular wall
infarction 11
Release of brain natriuretic peptide
(BNP) by stretched myocytes in blood

12
Symptoms are mainly a
consequence of pulmonary
congestion and edema &
Organ hypoperfusion →
cerebral, renal dysfunction.

Symptoms are chiefly


related to peripheral edema
and chronic venous
congestion (CVC) in visceral
organs causing enlargement
(most common
hepatosplenomegaly)
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What happens to liver in right heart failure?

Later fibrosis may develop → called as “Cardiac Cirrhosis”

19
Nutmeg liver:
Chronic venous congestion
(CVC) of liver occurring in
long standing right heart
failure

Passive congestion around


the central veins of liver.
The portal areas are
unaffected

20
Cardiomyopathy

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Definition
• Cardiac dysfunction resulting from a myocardial
abnormality which can be either inappropriate
ventricular hypertrophy or dilatation.

• Primary or secondary i.e. part of multi-organ


disorder

• Most common clinical feature → heart failure


and arrhythmias.
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Three pathologic patterns of cardiomyopathy

➢Dilated cardiomyopathy → systolic dysfunction

➢Hypertrophic cardiomyopathy
Diastolic
dysfunction
➢Restrictive cardiomyopathy

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Dilated cardiomyopathy (DCM)
• Progressive cardiac dilation and contractile (systolic)
dysfunction → systolic heart failure, arrhythmia,
intra-cardiac thrombus, embolism

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Dilated cardiomyopathy: Etiology
1. Genetic
2. Acquired
➢ Infection of myocardium (e.g. coxsackie B virus, HIV,
chaga disease, lyme disease, etc.)
➢ Toxic: e.g. Alcohol abuse, cocaine, certain drugs
➢ Metabolic: e.g. hypothyroidism, diabetes,
pheochromocytoma
➢ Ischemic heart diseases
➢ Peri-partum
➢ Infiltrative diseases: e.g. hemochromatosis
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Dilated cardiomyopathy (DCM)
• Gross: Heart is enlarged, heavy and flabby due to
dilatation of all four chambers of heart.
• Mural thrombi often present (white arrow).

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Hypertrophic cardiomyopathy (HCM)
• Genetic disorder
• Myocardial hypertrophy (no dilatation), poorly compliant
left ventricular myocardium leading to abnormal diastolic
filling.
• 30% patients: intermittent ventricular outflow obstruction.

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Restrictive cardiomyopathy (RCM)
• Primary decrease in ventricular compliance, resulting in
impaired ventricular filling during diastole.
• Contractile (systolic) function of the left ventricle is usually
unaffected.
• Myocardium is stiff & rigid; neither heart is dilated nor
myocardium hypertrophied
• Etiology
1. Idiopathic: Endomyocardial fibrosis
2. Loeffler endomyocarditis
3. Secondary to infiltrative diseases that makes myocardium
stiff e.g. radiation induced fibrosis, amyloidosis,
sarcoidosis, metastatic tumors
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Cardiomyopathy: Investigations

• Chest X ray
• Echocardiogram
• Cardiac CT scan
• Cardiac MRI
• Cardiac stress test
• Myocardial biopsy
• Genetic studies
• Investigations for Dilated LV in
secondary etiology DCM

31
Thank you

32

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