Assoc. Prof.

Anna Kaneva MD PhD

National Heart Hospital
 myocardial disease

 variety of conditions affecting principally the

myocardium
 Variable etiology
 similar clinical and physiologic states
Failure of the heart to:

 Act as a pump
 Initiate and maintain its rhythm
 Maintain its architecture
 Pumping failure congestive heart failure

 Rhythm disturbances
◦ Slowing conduction AV block
◦ Ectopic activity atrial, ventricular tachycardia

 Abnormal architecture cardiomegaly

 myocarditis

Myocardial
disease
Involvement in
cardiomyopathy
Systemic disease
 Clinical syndrome

Myocite inflammation
Infection
Toxic agent
Autoimmune process
unknown

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 Unknown
◦ 1,3 - 5 % sudden death syndrome
◦ ?? Mild and subclinical cases
 Viruses
◦ Adenovirus, Coxakie B, echovirus, grippe
 Protizoa (Trypanosoma cruzi  Chaga’s disease
 Bacteria
 Rickettsia
 Fungi
 Protozoa
 Immune mediated rheumatic fever, Kawasaki
 Collagen vascular disease
 Toxic myocarditis (drug ingestion, diphteria)
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 Viral invasion – penetration into myocite
◦ Direct viral-induced damage
◦ Post viral immune inflammatory reactions
 Inflammatory cell infiltrate
 Immune and autoimmune process
 Immune response
 Subtle onset to fulminate course
 Tachycardia + signs of congestive heart failure
 ECG
◦ Low voltage ECG
◦ ST-T changes
◦ Prolonged QRS
◦ Dysrrhythmias
 Xray
◦ cardiomegaly
 ECHO
◦ Chamber enlargement + depressed functon
  troponil levels
  creatin kinase + MB isoensime
 Emdomyocardial biopsy

 Viral tests – often negative

◦ Virus tests from blood, stool, throat washing
◦ Serologic tests
 Cardiothropic virus< 5 days

Focal myocite necrosis

Diffuse necrosis
> 7 - 10 days
polymorphic infiltrates

Continual
Fast recovery Fulminant course
Focal necrosis

Lethal
Recovery
Chronic myocarditis outcome
Dilated cardiomyopathy

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 70-80 % 20-30 %

Mild-moderate CHF severe CHF, Shock

60-70 % 10-20 % 10 %
recovery Dilated CMP Death

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 Bed rest in acute phase
 Treatment of CHF
◦ Diuretics
◦ Inotropic agents (dopamine, dobutamine)
◦ Oxygen
◦ Digoxin !!! Very carefully (1/2 digitalizing dose)
 Gamma globulin (2g/kg/24 h)
 ACE – captopril
 Amiodarone
 Corticosteroids?
diseases of the heart muscle, not
associated with congenital,
valvular, or coronary heart disease
or systemic disorders
 hypertrophic

Cardiomyopathy

dilated restrictive
 Familial disorder
  50% autosomal dominant inheritance
 LV hypertrophy
◦ Symetrical
◦ Asymetrical
◦ apical
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 Obstruction in LVOT
◦ Absent
◦ Stable
◦ progressive
 Syncope and sudden death
 Restriction in physical activity
 Negative inotropes
◦ Beta blockers
◦ Calcium channel blockers
 Relief of LVOT
◦ Myectomy
◦ Alcohol septal ablation
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Natural course – progressive deterioration

Management = management of CHF

Heart transplantation