Congestive Heart Failure
Jahangir Moini, Matthew Adams, Anthony LoGalbo in Complications of Diabetes Mellitus, 2022
Dilated cardiomyopathy occurs without other disorders that are able to cause the myocardium to be dilated. These include severe occlusive CAD, hypertension, and valvular heart disease. Sometimes, dilated cardiomyopathy starts with acute myocarditis (usually of viral origin). There is a latent phase of various lengths, then diffuse necrosis of the myocardial myocytes because of an autoimmune reaction to myocytes altered by the virus, and then, chronic fibrosis. The myocardium is dilated, thinner, and hypertrophied as a compensatory mechanism. This often results in functional tricuspid or mitral regurgitation as well as atrial dilation. Dilated cardiomyopathy affects both ventricles in most cases, less often affecting just the LV, and only rarely affecting just the RV. When chamber dilation and dysfunction progress, mural thrombi can form because of stasis of blood. The acute myocarditis and late chronic dilated phases are often complicated by cardiac tachyarrhythmias. Atrioventricular block may also develop. As the left atrium becomes dilated, atrial fibrillation often occurs.
Elements of Case Analysis
Julie Dickinson, Anne Meyer, Karen J. Huff, Deborah A. Wipf, Elizabeth K. Zorn, Kathy G. Ferrell, Lisa Mancuso, Marjorie Berg Pugatch, Joanne Walker, Karen Wilkinson in Legal Nurse Consulting Principles and Practices, 2019
Analysis: This case fact pattern describes a claim that would garner consideration for further investigation. Symptoms that do not respond as expected or worsen under treatment always require further evaluation. Unusual fatigue or new onset shortness of breath, particularly in women, should raise the suspicion of heart disease. Regarding causation, idiopathic dilated cardiomyopathy can be reversed or stabilized with proper treatment in the majority of cases. Disease progression will occur in a small minority of patients, whose hope for long-term survival rests with heart transplantation. The epidemiology of idiopathic dilated cardiomyopathy suggests that, with earlier diagnosis and treatment, this young woman more likely than not could have avoided transplantation and possibly reversed her disease. The delay in diagnosis left her with heart transplantation as her only viable treatment option.
Organic acid disorders and disorders of fatty acid oxidation
Steve Hannigan in Inherited Metabolic Diseases: A Guide to 100 Conditions, 2018
Symptoms of this condition may become apparent at any time from birth to 10 years of age, but usually appear during infancy or early childhood. The main symptoms include weakening of the heart muscle, which usually leads to enlargement of the lower chambers (dilated cardiomyopathy). There may also be thickening of the heart with overgrowth of fibrous and elastic tissues (endocardial fibroelastosis), or dilation of just part of the heart (left ventricular non-compaction). The dilation and thickening of the heart leads to a reduced ability to pump blood around the body (cardiac failure), and can cause breathlessness and fatigue on exertion, bluish discoloration of the skin (cyanosis) and irregular heartbeats (arrhythmias). Symptoms of heart failure are usually worst during infancy, but may improve and then deteriorate again during puberty. Arrhythmias are particularly common during the teenage years. There may be reduced levels of muscle tone (hypotonia) and muscle weakness, as well as a delay in physical development and growth, with ‘failure to thrive’ and short stature (although boys continue to grow late, and consequently often end up well grown). Some children may show falls in their blood sugar level (hypoglycaemia). Many children have food cravings, especially for savoury foods such as cheese, pickles and crisps. There are frequently low levels of the white blood cells known as neutrophils, which help to fight infections. This leads to a weakened immune system, and afected individuals become prone to infections and mouth ulcers.
Myocarditis and autoimmunity
Published in Expert Review of Cardiovascular Therapy, 2023
Akira Matsumori
Myocarditis, inflammation of the myocardium, may be acute or chronic, and persistent inflammation may progress to cardiomyopathy [1–3]. Myocarditis is often difficult to diagnose clinically because it may present with various signs and symptoms and may mimic other common heart diseases. However, early diagnosis is important since the treatment is different depending on the etiology, and an appropriate therapy can improve clinical course and prevent sequelae to dilated cardiomyopathy. Myocarditis is often caused by viral infections, but it is also associated with systemic autoimmune diseases, bacteria and other microorganisms, and drugs and other substances [1–3]. Persistent inflammation following acute myocarditis may lead to the development of dilated cardiomyopathy or cardiac dysfunction. Cytokines and immune cells that contribute to the innate immunity are involved in the inflammation of the acute stage, and the acquired immunity plays a role in the chronic stage [1–3]. Autoantibodies against various epitopes present on the heart were considered to contribute to the development of the disease [3,4].
CPR Induced Inappropriate Shocks from a Subcutaneous Implantable Cardioverter Defibrillator during Out-of-Hospital Cardiac Arrest
Published in Prehospital Emergency Care, 2020
Patrik Cmorej, Eva Smrzova, David Peran, Tana Bulikova
We present the case of a 30-year-old man who in 2006 underwent a heart transplant for terminal heart failure due to dilated cardiomyopathy. Twelve years after transplant the patient was placed on the waiting list for a second heart transplant. Given his high risk of sudden death, he underwent pre-transplant implantation of an S-ICD (EMBLEM MRI S-ICD, Boston Scientific) with a Conditional Shock Zone programed at 200 beats/min and a Shock Zone programed at 230 beats/min. The Shock Zone determines the heart rate threshold, which once reached triggers shock delivery based solely on the heart rate. In the Conditional Shock Zone, the device uses other elements to differentiate whether a shock is truly needed. Apart from the heart rate, these mainly involve the morphology of the QRS complexes (4).
LncRNA CAIF was downregulated in end-stage cardiomyopathy and is a promising diagnostic and prognostic marker for this disease
Published in Biomarkers, 2019
Di Wu, Yanqiu Zhou, Yudong Fan, Qingjun Zhang, Feifei Gu, Wen Mao, Miaomiao Zhang
End-stage cardiomyopathy as a main cause of deaths worldwide is characterised by increasing incidence, poor prognosis, and high economic cost (Vatta et al. 2002, Liu et al. 2018). The development of end-stage cardiomyopathy is complex. It has been reported that, genetic factors, such as mutated cytoskeletal proteins are correlated with familial dilated cardiomyopathy (Vatta et al. 2002). It has been well established that development of cardiomyopathy is accompanied by changes in expression pattern of various lncRNAs (Yang et al. 2015), and the involvement of lncRNA in different types of cardiomyopathy has been extensively reported by previous studies (Li et al. 2016). In the development of diabetic cardiomyopathy, lncRNA H19 targets VDAC1 and regulates cardiomyocyte apoptosis (Li et al. 2016). In the study of ischaemic cardiomyopathy, a series of lncRNAs are proved to be potential regulators of extracellular matrix gene expression (Huang et al. 2016). Based on our knowledge, involvement of lncRNAs in end-stage cardiomyopathy is unknown. A recent study reported that lncRNA CAIF attenuated myocardial infarction, indicating its possible involvement in cardiomyopathy. In our study, were observed significantly reduced expression levels of CAIF in myocardial tissues and serum of end-stage cardiomyopathy patients compared with healthy controls. Our findings may suggest that downregulation of CAIF is involved in end-stage cardiomyopathy.
Related Knowledge Centers
- Arrhythmia
- Cardiomegaly
- Chest Pain
- Edema
- Shortness of Breath
- Syncope
- Blood
- Heart Failure
- Shortness of Breath
- Valvular Heart Disease
- Genetics