Cardiomyopathy Causes & Symptoms | Cardiology🫀

today we will be discussing our about

cardiomyopathies cardiomyopathies our

special group of myocardial dysfunction

right in with this defect primarily

within the myocardium right now to make

that concept clear about cardiomyopathy

right or the disease of the myocardium

you have to remember that there are

certain conditions which should be

saluted right

for example myocardial damage due to

high blood pressure hypertension

myocardial damage due to is coronary

artery disease or myocardial damage

which is due to valvular heart disease

valvular heart disease and congenital

heart disease and then we can talk about

inflammation these five conditions are

not included in cardiomyopathies when

there are myocardial damages related

with hypertension a myocardial damage

related with coronary artery disease or

myocardial damage secondary to welder

all disease or myocardial damage related

with the congenital conditions or

myocardium is inflamed when actively

inflamed all these conditions are not

included in cardiomyopathies right it

means that cardiomyopathy is due to some

intrinsic defect in myocardium or some

disease which lead to primary

abnormality within the myocardium which

is not due to hypertension again what is

cardiomyopathy cardiomyopathy is

pathological conditions of myocardium

which are not due to hypertension not

due to coronary artery disease is not

due to well or heart disease is not due

to congenital heart diseases and in

which myocardium is not actively

inflamed right primarily cardiomyopathy

they are divided into three groups

primarily cardiomyopathies are divided

into three groups

and these are dilating dilated

cardiomyopathy cardiomyopathy

hypertrophic hyper trophic

cardiomyopathy and there is restrictive

cardio myopathy restrictive restrictive

cardiomyopathy this dilated

maybe there's a hypertrophic

cardiomyopathy and there is restrictive

cardiomyopathy a simple diagram let's

see how they are different from each

other in dilated cardiomyopathy what

really happens that left ventricle is

pathologically dilated or even right

ventricle is also pathologically dilated

right dilated cardiomyopathy which is

also called congestive cardiomyopathy

then little cardiomyopathy is also

called unjust if cardiomyopathy in this

case what really happens that myocardium

become ballooned out its pathologically

dilated and this pathologically dilated

myocardium cannot contract well it

cannot contract well there is global

hypokinesia of the myocardium this is

global impairment in the movement of

myocardium hypokinesia mean movement of

myocardium this global impairment in the

contractility of myocardium if you want

to remember a single sentence there is

global impairment in the contractility

of myocardium usually left ventricle as

well as right one zero is the right it

is slowly contracting poorly contracting

hard or we can say it's hypokinetic

heart it is large but hypo kinetic heart

and of course it's a failing heart and

this this failure will be - slowly

failure or systolic failure it is it is

not diastolic failure because during the

- Slee it can accommodate the incoming

blood but during the systole it cannot

contract well so this is basically a

systolic failure dilating cardiomyopathy

which is right ventricular and left

ventricular both both ventricles become

ballooned out they like a balloon they

enlarge they become very poorly

contractile chambers and we say that

de-rating cardiomyopathy the condition

in which this biventricular failure with

pathologically dilated both chamber

and remember this global impairment in

contraction because if there is only

segmental impairment in contraction that

maybe is chemic heart disease but in

cardio myopathy gelatine cardiomyopathy

there is global problem throughout the

myocardium does that right so this is

clinically coming as systolic failure

its systolic failure failure of

contraction the real problem is systolic

failure and patient will develop right

now opposite to that hypertrophic

cardiomyopathy is different hypertrophic

cardiomyopathy is different in this case

this pathological hypertrophy of

myocardium let me explain that let's

suppose this is the normal left

ventricular chamber suppose this is the

normal nephron tubular chamber and here

is your aortic valve here is your your

design now when it undergoes

hypertrophic cardiomyopathy it develops

pathological hypertrophy and specially

the siper trophy is very pronounced in

septum other part of myocardium is only

mildly hypertrophic but septum

interventricular septum is grossly

hypertrophied very severely hypertrophic

and specially in this case which part of

the myocardium is hypertrophic both

septum which part of the septum upper

part of the septum right now this septal

hypertrophy right it has a very special

type of hemodynamic problem look here

ventricle will contact strongly because

there is more muscle it will contract

strongly it is hyperkinetic hard it is

hyper kinetic heart remember dilated

cardiomyopathy will hypokinetic this is

hyper connected but there is one problem

look here please attention here

you know whenever ventricle contract

septum becomes shorter

septum becomes shorter and then septum

becomes shorter this obstruction bulges

in the cavity this obstruction will

belgin during every systole this

obstruction specially in 30 40 % of

these patient this obstruction

dynamically during the systole or

contraction bulges into cavity and when

it will bulge further into cavity it

will produce an obstruction to outflow

it will produce an obstruction to the

outflow right so it is not normal

hypertrophy you know i Petroff is seen

in hybrid hypertension disease

hypertrophy seen in your text in OSes

that hypertrophy is usually symmetrical

hypertrophy symmetrical mean that

hypertrophy is equal in all parts for

example if I'm having hypertension right

let's suppose someone has hypertension

or your aortic stenosis then hypertrophy

will be equal and symmetrical in all

part of myocardium so this type of

hypertrophy is called

symmetrical hypertrophy we are cavity

remain oval or ovoid but in this

particular condition the hypertrophy is

asymmetrical so some people call it

hypertrophic cardiomyopathy as

asymmetric cardiomyopathy the college

asymmetric hypertrophic cardiomyopathy

is neutral this point is very important

because septum is too much hypertrophic

as compared to the remaining myocardium

and during contraction when septum

shrinks right then this obstruction

become more pronounced because when it

will shrink in this way it will bulge as

a big obstruction to the outflow because

it produces outflow obstruction this is

very commonly called hypertrophic

obstructive cardiomyopathy and the name

is that there is hypertrophy which is

leading to obstruction hypertrophic of

have cardiomyopathy or simply call it

obstructive hypertrophic cardiomyopathy

is that right now and you confuse these

two conditions is a very different this

is poorly contacting heart it is

vigorously contracting strongly

contacting heart here on echocardiogram

you find a very big heart with a very

big cavity is the right and Julie

thin-walled

myocardium and myocardial contractility

is poor throughout all elements of the

wall but when you check this

hypertrophic cardiomyopathy on the

echocardiography number one you find

this hypertrophy and number two is more

important than number one that

hypertrophy is asymmetrical especially

septal hypertrophy is more pronounced

than the free wall hypertrophy of the

ventricle currently cavity of the cavity

of the ventricle is abnormal it's

something like banana ship now look at

this cavity it's something like banana

shaped cavity so this is abnormal you

can say that cavity of this is right

this is banana shaped cavity right right

now this is balloon like this is banana

ship is that right

now these two I hope you will not

confuse now we come to the third type of

hypertrophy and in third type of

hypertrophy first you look at the

ventricle a third type of cardiomyopathy

and third type of cardiomyopathy what's

wrong that there are pathological

infiltrations they are pathological

infiltration Zinda what is this

myocardium and due to this pathological

infiltrations myocardium become firm and

the real problem is failure to

relaxation a real problem is I should

write it here

case the real problem is failure to

relaxation failure to relaxation right

that during this is look at it due to

infiltration this become thickened you

too thick myocardium right

and this myocardium which is thick right

it feel to relax properly it feel to

relax properly and because it does not

relax properly do you think during

diastole it will fill properly no so it

will lead to a problem during the - lay

that function of the myocardium is that

during systole should contract well and

during - Lee should relax normal

function of myocardium is during the

isolation relax so that incoming blood

can be accommodated so that it can be

pumped in the next feed but the problem

is this here the left ventricle our

ventricular wall is infiltrated with

some for example like amyloid material

abnormal protein or infiltrated with

sarcoid granulomas or infiltrated by you

can say what is this

hemochromatosis immigrant offices iron

overloading conditions so if there is

some pathological infiltrations

and myocardial wall become thick and

firm and it failed to relax during - lee

it will lead to diastolic failure it

will lead to what type of failure

diastolic failure soon echocardiography

because one of the best way to diagnosis

echocardiography in echocardiography in

dilated cardiomyopathy is you find that

ventricles are ballooned out and thinned

out right and they are very poorly

contractile and leading to systolic

dysfunction or systolic failure this is

the right hypokinetic heart

when we talk about hypertrophic

obstructive cardiomyopathy this is the

second group of the problem

what's wrong with the second group that

is pathological asymmetric hypertrophy

of the myocardial ventricular walls and

the maximum hypertrophy is seen in the

interventricular septum especially in

its upper part right and the main

problem here is not contractility main

problem is abnormal dynamics of

contraction due to outflow obstruction

is right the real problem is not the

contraction right from curtain it is

okay but curtain contractility becomes

abnormal due to abnormal cavity and due

to an element of dynamic obstruction you

know if there's a or ticks tneows is

obstruction that is called fixed

obstruction but when this septum you

know it bulges into cavity and when it

during systole when it bulges in the

cavity even mitral valve also hit here

so both of them together they act as

outflow obstruction that is why this

asymmetrical hypertrophy which is

leading to outflow obstruction nephron

tubular cavity outflow obstruction is

also called hypertrophic obstructive

cardiomyopathy okay there's only one

Center if you want to remember only one

sentence about this condition if you

want to remember only one sentence let

me turn this type of cardiomyopathy is

50% cases are 50% cases are familiar

familial but 100% cases of genetic

mutation 100% almost hundred-percent

patient have genetic defect I will

explain it later out of this 50% cases

are familial and 50% cases are sporadic

for example if you have 100 patient with

the hypertrophic obstructive

cardiomyopathy and 50% patient you will

find a family history of such problems

and 50% of them you will not have the

family history it means there is also

mutation here there's also mutation here

but this mutation is a new mutation this

is a new mutation and this is a mutation

which is inherited

generation after generation it is

autosomal dominant autosomal dominant

mean that out of two alleles even if one

gene is defective disease will be there

this is the right out of you know one

gene come from weather and other set of

gene come from father even if one set of

gene is defective disease will be there

right so what we is really see here that

it is 50 percent almost 100 percent

cases they have mutations out of them 50

percent have inherited mutations 50

percent of sporadic cases but yet the

most important sentence is not there the

most important sentence related with

this is that the most important concept

related with this is there this is a

cause of unexplained death in the jungle

it's especially in the boys yeah yeah in

some family may be you mother tell the

young boy please don't play too much

don't play do the aggressive athletic

activity your father died in the ground

suddenly right but why you know boys

don't listen when they are a dollar sign

he may go into vigorous activity right

and he may suddenly one day collapse on

the ground and die at the spot and later

on autopsy you will find that there is

hypertrophic obstructive cardiomyopathy

this is the more

common cause of sudden cardiac death in

young athletes during the vigorous and

physical activity right there's the most

important cause what is the reason that

isn't being when they're doing a lot of

physical activity is their right heart

become more dynamic and if heart is

becoming more dynamic obstruction become

more pronounced and when obstructions

become more pronounced it becomes more

difficult to eject is a right and doing

the physical activity not only of

obstruction is more pronounced it means

you know outflow will be less an erotic

feeling will be less pressure in

irritable drop very severe exercise is

obstruction right obstruction which is

increased in dynamic City as heart rate

goes up your aura is overfilled or under

failed under fail at the top when his

real physical activity most of the

arterioles will relax

so whatever blood is here it will be

stolen away by the peripheral system so

very little blood is left to perfuse

coronary artery so when they do lot of

physical activity the cardiac output

drops because during severe physical

activities and sympathetic nervous

system is more active heart rate goes up

obstruction become more dynamic outflow

become less at the top during physical

activity most of the muscles blood

vessels relaxed arterioles relax so

blood will wash away to less resistant

areas so there will be more blood flow

to the muscles pressure in the root of a

rota is less very little blood go into

the myocardium this may precipitate

severe ischemia and conduction

abnormalities and fatal cardiac

arrhythmias so what really happens to

this patient that patient may undergo

fatal cardiac ventricular of course

arrhythmias and - may be there at the

spot so hope first and second case you

will not confuse right in third case

it's entirely different problem is that

ventricle failed to relax regular wall

the thick hair size is almost normal but

ventricle is thick

failed to relax during - clay failed to

accommodate enough preload failed to

accommodate an offender's frolic volume

right and that will lead to back

pressure is that right let us have a

break and then we'll continue

you