Cardiomyopathy , HOCM In MRCP Part 1

Cardiomyopathies

Introduction

Myocardium is the main functional part of the heart. Heart failure is synonymous with failure of cardiac muscle. Myocardium may be affected by disease of muscle itself ( Primary) or due to effect of other disease process ( Secondary) or by coronary artery disease. Interestingly, as cardiac muscle is anatomically related with skeletal muscle ( striated muscle) , primary disease of skeletal muscle involves cardiac muscle also.

 Clinical types of Cardiomyopathy

Mainly as below:

  • Dilated cardiomyopathy ( Systolic heart failure)
  • Hypertrophic cardiomyopathy of multiple varieties ( Diastolic heart failure)
  • Restrictive cardiomyopathy ( Diastolic heart failure)

Of them, HOCM ( Hypertrophic Obstructive Cardiomyopathy) is the most common.

Clinical Presentation

Patient presents with symptoms of dyspnoea, angina and syncope due to outflow obstruction. Moreover there would be other-

  • Clinical features of Heart failure
  • Clinical features of Arrhythmia
  • Clinical features of primary disease / cause

 Bad prognostic feature ( risk factors of sudden cardiac death) of HOCM

Exercise induced hypotension is the most important

Investigation ( ECG, Echo, Electrophysiological Study, BNP, Electrolyte etc)

  • To diagnose heart failure ( eg Echo or cardiac MRI)
  • To identify causes of heart failure eg IHD
  • To identify complications eg renal function
  • To identify prognostic factor or co morbidities

Management

  • Management of heart failure
  • Management of Arrhythmia ( eg ICD)
  • Management of primary disease / cause

 


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