Cardiomyopathy is a disease of the heart muscle caused by different causes (genetic causes are the most common). This disease is organic, including abnormal cardiac mechanical activity and/or cardiac electrical dysfunction. Pathologically, it manifests as inappropriate dilation or hypertrophy of the ventricles, affecting the systolic or diastolic function of the heart. This can ultimately lead to severe heart failure, atrial or ventricular arrhythmias, or embolism.

Cardiomyopathy can be divided into dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy, Arrhythmogenic cardiomyopathy and indeterminate cardiomyopathy, the first three cardiomyopathies are more common.

·Incidence rate: According to our country’s statistical data, the incidence rate of dilated cardiomyopathy It is (13~84)/100,000; the prevalence rate of hypertrophic cardiomyopathy is 180/100,000.

·Predisposed groups: those with a family history of cardiomyopathy, viral myocarditis, long-term heavy drinking, and taking myocarditis People with a history of toxic drugs, malnutrition, and endocrine system diseases are those with a high risk of cardiomyopathy.

·High incidence season: There is no obvious seasonal difference in the occurrence of cardiomyopathy, but the incidence of heart failure increases in winter.

·Survival rate: The prognosis of dilated cardiomyopathy is poor, with a 5-year survival rate of about 50% and a 10-year survival rate of only about 25%; The prognosis of hypertrophic cardiomyopathy varies greatly; the 5-year survival rate of restrictive cardiomyopathy is about 30%.

In 2007, the European Society of Cardiology classified cardiomyopathy into dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy, arrhythmogenic cardiomyopathy and undetermined cardiomyopathies, each of which can be divided into hereditary and non-hereditary.

Several types of cardiomyopathy have no clear clinical stage definition.

Several types of cardiomyopathies are not clinically graded, but cardiac function It can be classified according to the New York Heart Association (NYHA) method.

The cause of most cardiomyopathies remains unclear, but is currently related to the following factors:

High-risk factors for cardiomyopathy include:

The onset of cardiomyopathy is insidious and slow. Most patients have no obvious symptoms in the early stage. They often show symptoms during physical examination. It is only then discovered that the heart is enlarged, and some only show weakness and reduced exercise tolerance, usually not attract attention. Most patients take several years (up to 10 years) to develop more obvious symptoms.

Typical symptoms of cardiomyopathy include congestive heart failure, the most common of which are shortness of breath and edema.

Shortness of breath is the main manifestation of left heart failure. At first, shortness of breath occurs only after exertion and activity tolerance decreases. As the disease progresses, shortness of breath may also occur during light physical activity or at rest. After the condition worsens, paroxysmal dyspnea or orthopnea occurs at night.

Symptoms of right heart failure may first appear in low-hanging parts of the body, such as edema in the lower limbs. Eyelid edema may occur in the early morning, and the edema is symmetrical and sunken. As the disease progresses, Symptoms such as jugular vein filling or distension, ascites, and systemic edema may occur.

In addition to the typical clinical manifestations of heart failure, some patients are also accompanied by the following symptoms:

Patients with cardiomyopathy should go to the Department of Cardiovascular Medicine or Cardiovascular Surgery. When your condition is critical, go to the emergency department first, and then seek consultation from relevant departments. (Those who engage in high-intensity competitive activities such as marathon running should An echocardiogram is performed to rule out hypertrophic cardiomyopathy. )

The doctor’s process for diagnosing this disease:

The diagnostic criteria for various types of cardiomyopathy are as follows:

Patients with cardiomyopathy generally have an accelerated heart rate and decreased blood pressure in the late stages during physical examination. The pulse pressure is small, the pulse is weak, and some have alternating pulses. The jugular vein is visible in right heart failure Fullness or distension, liver enlargement, edema of both lower limbs, and even pleural effusion and ascites.

Cardiac specialist examination shows that the apex pulse is displaced, there may be lifting-like pulses, and the relative dullness of the heart is inconsistent. With the same degree of enlargement, the heart rhythm may be irregular, the heart sounds may be low and dull, and ventricular galloping may be heard in patients with severe heart failure. Rhythm, if the valve is relatively insufficient, a systolic blowing murmur can also be heard. hypertrophic obstructive Patients with cardiomyopathy may also hear a rough systolic ejection murmur in the third and fourth intercostal spaces on the left sternal edge.

Patients with cardiomyopathy need to undergo relevant hematological tests such as cardiac enzymes and autoantibodies, and necessary laboratory tests such as electrocardiogram, Echocardiogram, etc. You can choose whether to perform cardiac CT or magnetic resonance examination according to the condition. If the diagnosis cannot be clear, If conditions permit, subendocardial myocardial biopsy may be considered. Genetic testing or screening can be helpful for hereditary cardiomyopathies.

Dilated cardiomyopathy needs to be combined with other heart diseases such as coronary heart disease, valvular heart disease, congenital heart disease, Differentiate between hypertensive heart disease and cardiac enlargement and hyposystolic function caused by secondary cardiomyopathy.

Hypertrophic cardiomyopathy needs to be related to physiological myocardial hypertrophy, congenital heart disease, hypertensive heart disease, Aortic valve stenosis and other phases are differentiated, and these diseases can also lead to ventricular hypertrophy.

Restrictive cardiomyopathy needs to be differentiated from constrictive pericarditis, scleroderma, sarcoidosis, glycogen storage disease, etc.

Arrhythmogenic cardiomyopathy: It needs to be differentiated from diseases involving the right ventricle, such as myocarditis, idiopathic right ventricular tachycardia, and sarcoidosis.

The above types of cardiomyopathy can be diagnosed through medical history, physical examination, echocardiography, cardiac catheterization, Cardiac CT and magnetic resonance examinations are performed to differentiate from other diseases, and subendocardial myocardial biopsy is performed when necessary.

·Improve patients’ clinical symptoms, prevent further deterioration of the condition, and reduce the occurrence of complications, Improve patients' quality of life, control the occurrence of arrhythmias and prevent sudden death.

·Treatment needs to be individualized, and the main methods include drug treatment, intracardiac minimally invasive interventional treatment, and surgical treatment.

Patients with cardiomyopathy who experience severe dyspnea, syncope, etc. need emergency treatment to avoid life-threatening situations.

First aid measures: In case of severe dyspnea, the first step is to keep the respiratory tract open, inhale oxygen through a nasal cannula or mask, and open intravenous channels. Strictly limit the amount of water entering. In the event of syncope, an electrocardiogram should be performed urgently to observe whether there is arrhythmia and targeted medication should be administered.

Self-rescue measures: When having difficulty breathing, patients can sit in a semi-sitting position with their legs hanging down to reduce the amount of venous blood returning to the heart and relieve the pain. Heart burden; if dizziness occurs, be sure to prevent falls and injuries, and notify family members to seek medical attention immediately.

Patients and their families should understand the relevant knowledge about cardiomyopathy, get guidance from doctors and know how to self-manage. Including healthy lifestyle, stable mood, avoiding triggers as much as possible, standardized drug treatment, follow-up plan, etc.

Lifestyle adjustment: Pay attention to a diet that is low in salt and fat, eat small amounts with frequent meals, and is light and easy to digest; pay attention to controlling the daily water intake and monitoring your weight every day; Strictly limit or abstain from alcohol; pay attention to rest, limit strenuous physical activities, and avoid overexertion.

Hospital care: If you have difficulty breathing, you should be in a semi-recumbent position or a high pillow position with your legs hanging down. Those with pleural effusion or ascites should be in a semi-recumbent position. Strictly control the daily infusion volume and fluid intake, record the 24-hour intake and output and daily weight, and avoid drinking a large amount of soup or water in a short period of time. People who are bedridden for a long time need to use air mattresses and change positions frequently to prevent bedsores.

Due to large individual differences, there is no absolute best, fastest, or most effective medication. In addition to over-the-counter drugs, the most appropriate drug should be selected based on individual circumstances under the guidance of a doctor.

The principles of drug treatment for cardiomyopathy are the same as those for general heart failure. Inotropic drugs, Angiotensin-converting enzyme inhibitors (ACEI), diuretics, vasodilators, beta-blockers, etc. If there is arrhythmia, arrhythmia-specific drugs will also need to be added. Some also need to add anticoagulants to prevent thrombosis.

·Diuretics

·Beta blockers

·Sacubitril/valsartan sodium

·Angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonist

· Positive inotropes

·Ivabradine

·Mineralocorticoid receptor antagonists

·Antiarrhythmic drugs

·Calcium channel blockers

·Anticoagulation therapy

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Cardiomyopathy is currently mostly treated with medication, but sometimes surgical procedures such as ventricular septal resection can also be used. Removal of hypertrophied myocardium; some patients with end-stage cardiomyopathy may choose heart transplantation as a short-term transitional treatment Left ventricular assist devices are optional. In addition, minimally invasive intracardiac interventional therapies such as cardiac resynchronization therapy, Cardiac pacing therapy, radiofrequency ablation therapy, alcohol septal ablation, see interventional therapy for details.

·Ventricular septal resection

·Heart transplantation

·Left ventricular assist device therapy

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The following interventional therapies are available for some patients with cardiomyopathy.

·Cardiac Resynchronization Therapy (CRT)

·Radiofrequency ablation

·Alcohol septal ablation

Abnormal light chain cardiac amyloidosis can be treated with a combination of bortezomib and dexamethasone. It can inhibit the synthesis of abnormal protein light chains by bone marrow plasma cells, improve left ventricular function, and prolong the patient's life.

In patients with dilated cardiomyopathy, certain traditional Chinese medicines such as Qili Qiangxin Capsules can improve heart failure symptoms and increase exercise tolerance.

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·Dilated cardiomyopathy

·Hypertrophic cardiomyopathy

·Restrictive cardiomyopathy

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·The prognosis of arrhythmogenic cardiomyopathy is uncertain, and the main cause of death is sudden death, which is more common in young people.

Cardiomyopathy is currently difficult to cure and cannot heal itself. After treatment, the patient's clinical symptoms can be improved. Prevent further deterioration of the condition, reduce the occurrence of complications, and improve the patient's quality of life.

·Self-healing property: Cardiomyopathy has no self-healing property.

·Radicality: Cardiomyopathy is difficult to cure, but treatment can improve symptoms and improve survival rates.

Cardiomyopathy is a serious heart disease. Once the patient develops symptoms, it will affect his normal life and work. As the disease progresses and the symptoms of heart failure worsen, symptoms such as edema and dyspnea will appear. Normal life and rest will be impossible, and the quality of life will be further reduced, bringing heavy burden and pain to patients, families and society.

Patients with hypertrophic cardiomyopathy and arrhythmogenic cardiomyopathy, especially young adults, are at risk for sudden death.

In patients with cardiomyopathy, the thrombus in the heart cavity breaks off and embolizes to the brain or other parts of the body. Corresponding sequelae may occur, such as hemiplegia, limb paralysis, loss of motor ability, dysphagia, Decreased memory or thinking ability, pain or numbness in parts of the body, changes in behavior, or decreased ability to care for oneself.

If patients with cardiomyopathy do not have an acute exacerbation of heart failure, they can do some active or passive measures appropriately. Exercise training, because long-term bed rest can lead to venous thrombosis and even the risk of pulmonary embolism.

Common complications of cardiomyopathy include:

Cardiomyopathy is currently difficult to cure. The patient's clinical symptoms can be improved after treatment, but heart failure can occur repeatedly and require hospitalization.