Antihypertensive therapy for hypertrophic cardiomyopathy which part
What is cardiomyopathy?
Myopathies are muscle diseases. Cardiomyopathies are diseases of the heart, which mainly consists of muscles. Either enlargement, hardening or expansion / inflation of individual parts of the heart occur, which can lead to mechanical or electrical malfunctions of the heart. If this is the case, sudden deaths can occur or one is limited in everyday life and no longer as productive due to the malfunction of the heart. Most cardiomyopathies are genetic, i.e. inherited from the mother or father.
What happens with cardiomyopathy?
To understand the problems associated with cardiomyopathies, it is necessary to consider some properties of the heart. The heart is like a pump that constantly supplies the body and organs with oxygen-rich blood.
This pump consists of two parts. On the one hand, the heart has a right part that is responsible for taking in the oxygen-poor blood from the body and transporting it to the lungs. This right part is again divided into two parts. The right atrium, which takes in the body's “used” blood, and the right ventricle connected to it, which then pumps the blood to the lungs. Oxygen is then added to the blood again in the lungs. This oxygen-rich blood now enters the second part of the heart, the left atrium, to which another chamber is connected, the left ventricle. This left ventricle pumps the oxygen-rich blood back into the body.
Once the blood has released its oxygen to the body and organs, it is "sucked in" again from the right atrium and pumped back into the lungs from the right ventricle. This closes the blood circulation. The pumping process of the heart is achieved by the fact that the heart, which consists mainly of muscles, can contract in order to carry the blood forward. If the heart is enlarged or hardened, problems moving the blood can arise. Myocardial diseases are mostly responsible for this, which will now be briefly presented.
Heart muscle diseases (cardiomyopathies) can be divided into dilated, hypertrophic and restrictive cardiomyopathies based on their changes in the structure and shape of the heart, which will now be explained.
Dilated cardiomyopathy (DCM)
The most common form of cardiomyopathy is dilated muscle disease (15 cases per 100,000 population). In dilated cardiomyopathy (DCM), one or both atria are enlarged or widened, which means that they can no longer carry the blood well enough because the heart can no longer contract as well due to the enlargement.
In this context, one has to imagine the heart as a limp sack that can no longer build up enough tension to carry the blood on. The causes are either unknown, inherited, triggered by a virus, triggered by toxins (especially alcohol) or arise from another heart disease (e.g. Coronary heart disease or Valvular heart disease ).
In 60% of affected patients, dilated cardiomyopathy develops following a healed virus attack on the heart muscle. Men who are 40 years old or older are particularly affected.
Many cardiomyopathies also occur because the heart is receiving too little oxygen due to coronary artery disease or because too much alcohol has been drunk. Cardiac arrhythmias often occur, which the patient calls dizziness Experience, fainting or conscious awareness of one's own heartbeat. If you experience these symptoms, you should see a doctor as soon as possible, as dilated cardiomyopathy (DCM) can cause sudden cardiac death. In addition, the increased blood "standing" in the atrium can cause blood clots to form, which can clog various vessels in the body. If, for example, a vessel that is responsible for supplying the brain is blocked, this can lead to a stroke. It can also lead to circulatory disorders in the arms and legs or other parts of the body.
Dilated cardiomyopathy (DCM) is a common cause of one Heart transplant if the patient cannot be helped with medication, a pacemaker or an operation to widen the supplying heart vessels.
If dilated cardiomyopathy (DCM) is suspected with typical symptoms, the diagnosis is made by listening to the heart, imaging tests ( Cardiac ultrasound , Cardiac MRI ) or by removing tissue from the affected area. In addition, you can determine the size of the heart with the help of an X-ray machine. Furthermore, a thin tube can be inserted through a vessel into the heart ( Cardiac catheter ). At the end of this tube there are sensitive sensors that can measure the pressure conditions and the pumping behavior of the heart.
On the one hand, dilated cardiomyopathy (DCM) can be treated with medication, as these have a positive effect on the pumping behavior of the heart. In addition, you can with serious Arrhythmia one Pacemaker deploy. It is also important that the patient no longer consumes alcohol. In addition, other heart-stressing disorders such as fever, high blood pressure and anemia are treated. Drugs used to prevent blood clotting can also improve symptoms of DCM. In the last resort there is the possibility of a heart transplant, whereby mechanical pump systems can take over the heart function until a new heart is available for a transplant.
Annual mortality after the disease is diagnosed and treated is 10-20%, and this rate has improved in recent years with modern cardiac therapy.
Hypertrophic cardiomyopathy (HCM)
Hypertrophic cardiomyopathy (HCM) is the second most common form of cardiomyopathy. On average, one in 500 young adults is affected. The hypertrophic cardiomyopathy HCM is genetic. It is a congenital heart muscle disease that is usually associated with an irregular thickening of the left ventricle.
It affects the part of the heart that is supposed to carry blood from the lungs to the body. In some of the patients, physical exertion leads to an increasing narrowing of the outflow path of the left ventricle, since the thickened part of the heart compresses the outflow path for the blood. In addition, the heart muscle stiffens.
Many patients experience no symptoms or few complaints. However, when symptoms do occur, 90% of the affected patients feel short of breath because the heart chamber can only fill to a limited extent and the blood backs up in the vessels that are supposed to transport the blood from the lungs to the left heart section. In 75% of patients with physical complaints occur Chest pain that may spread to the neck or left arm (angina pectoris). In addition, patients suddenly become aware of their heartbeat, develop cardiac arrhythmias, suffer fainting attacks, and in the worst case scenario, sudden cardiac death can occur.
The doctor can diagnose hypertrophic cardiomyopathy HCM by listening to the heart. In addition, the electrical activities of the heart can be displayed using an electrocardiogram (EKG). There is also the possibility of recording a long-term EKG, which measures the electrical activities over a longer period of time. The heart can also be examined using an ultrasound machine, a catheter or an X-ray machine.
Hypertrophic cardiomyopathy (HCM) can be treated with drugs that lower the strength of the heart. In addition, the excess heart muscle can be surgically removed or a pacemaker can be used. Avoiding excessive physical strain is also important.
The most common complications are sudden and progressive cardiac death Heart failure . The annual mortality rate in hypertrophic cardiomyopathy (HCM) patients is 1%, whereas hypertrophic cardiomyopathy (HCM) in childhood and adolescence has a very poor prognosis. However, 25% of patients with hypertrophic cardiomyopathy (HCM) reach the age of 75 years.
In restrictive cardiomyopathy, extra tissue is built into the heart muscle, which hardens the heart. This disease affects twice as many women as men. The main reason is that proteins are deposited between the heart cells. As a result, the chambers of the heart can no longer fill so well with blood because they are hard instead of limp. For example, a hard balloon is harder to inflate than a soft one. This causes the blood to build up in front of the ventricles in the atria, which enlarges them. The heart's proper pumping function is therefore no longer guaranteed.
The first noticeable symptoms are shortness of breath during physical exertion and accumulations of water / swelling in the legs, as the heart is weak. In addition, arteries can become blocked (embolism) and fluid can collect in the lungs because a vessel in the lungs is blocked (pulmonary embolism). Chest pain that can radiate to the neck or left arm (angina pectoris) is rare.
To find out whether there is a restrictive cardiomyopathy, one can examine the electrical activity of the heart with an EKG, take an x-ray of the chest and heart (chest x-ray), examine the heart with an ultrasound device (echocardiography), insert a tube into the heart which uses sensors to measure how much pressure the heart can generate to carry the blood (cardiac catheter), remove and examine tissue from the heart (heart biopsy) or take pictures of the heart using an MRI.
For therapy, anti-coagulation medication can be given or muscle mass can be surgically removed, although there is a high mortality rate after the operation.
Heart muscle diseases are mostly chronic and insidious and are therefore noticed relatively late. Once a restrictive cardiomyopathy is diagnosed, the disease usually progresses rapidly. In tropical countries, 95% of affected people die after two years.
Angstwurm, Matthias and Kia, Thomas (2013): Mediscript StaR 1; Cardiology and angiology. Munich: Urban and Fischer
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