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Professional differential diagnosis of cardiomyopathy


Professional differential diagnosis of cardiomyopathy

Professional differential diagnosis of cardiomyopathy

Cardiomyopathies are myocardial diseases in which the heart muscle is structurally and functionally altered in the absence of coronary artery pathology, arterial hypertension and lesions of the valve apparatus. Cardiomyopathies are classified as primary (idiopathic) with no known cause and secondary with known etiology.
Primary cardiomyopathies
• dilated or congestive cardiomyopathy;
• Hypertrophic cardiomyopathy (subaortic stenosis);
• Restrictive cardiomyopathy (endomyocardial fibrosis)
• Arrhythmogenic right ventricular dysplasia (Fontana's disease).

The group of secondary cardiomyopathies is extensive and includes myocardial lesions in various diseases and pathological conditions. Among secondary cardiomyopathies, the most common are alcoholic cardiomyopathy, thyrotoxic cardiomyopathy, takotsubo cardiomyopathy, diabetic cardiomyopathy, etc.

I. Cardiomyopathy, idiopathic dilatation
• Basics of diagnosis
• Contractile dysfunction with left ventricular enlargement; symptoms of heart failure develop in the later stages of the disease;
• No signs of coronary artery disease, heart valve damage, persistent hypertension, alcoholism, or other causes of cardiomyopathy;
• The prevalence is 0.04%;
• The disease is three times more common in men than in women;
• Familial predisposition is often revealed, reaching 20%

Differential diagnosis
• Cardiac ischemia;
• Diseases of the heart valves;
• Hypertensive heart disease;
• Cardiomyopathy associated with thyroid dysfunction;
• Cardiomyopathy caused by the human immunodeficiency virus (HIV).

• Angiotensin-converting enzyme inhibitors and b-blockers;
• Diuretics and digoxin to relieve symptoms;
• Spironolactone with severe heart failure;
• Implantation of a cardioverter - defibrillator in survivors of sudden death and patients with unexplained loss of consciousness;
• Heart transplant in patients with advanced disease, even with optimal therapy (if the transplant criteria are met)

The prognosis is much more favorable than with ischemic cardiomyopathy. In addition, b-blockers normalize left ventricular function in 10% of patients.

II. Tachycardia-induced cardiomyopathy
Diagnostic basics
• Typical dilated cardiomyopathy with reduced contractile function;
• Ventricular or supraventricular tachycardia (not sinus) lasting more than 3.5 hours.

Differential diagnosis
• Suspect idiopathic dilated cardiomyopathy if left ventricular function does not improve with tachyarrhythmia control or cessation;
• Other forms of heart failure with sinus tachycardia.

1. Medical therapy or ablation of the atrioventricular node in combination with a pacemaker to control the heart rate;
2. Electric pulse therapy (cardioversion) for ventricular tachycardia, atrial fibrillation or atrial flutter;
3. Drug therapy or ablation to correct tachyarrhythmias.
Tachyarrhythmias can worsen decompensation in patients with heart disease.

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