Cardiomiopatii dilatative.pdf

8/14/2019 Cardiomiopatii dilatative.pdf

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CARDIOMIOPATIA

DILATATIV|


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Report of the 1995 World Health

Organization/International Society and Federation of

Cardiology Task Force on the Definition andClassification of Cardiomyopathies


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Dilated Cardiomyopathy

Dilated cardiomyopathy is characterized by dilatation and impaired contractionof the left ventricle or both ventricles. It may beidiopathic,familial/genetic,viral345and/or immune,67alcoholic/toxic, or associated with recognized

cardiovascular disease in which the degree of myocardial dysfunction is not

explained by the abnormal loading conditions or the extent of ischemic damage

(see below). Histology is nonspecific.
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Dilated Cardiomyopathy

Dilated cardiomyopathy is characterized by dilatation and impaired contractionof the left ventricle or both ventricles. It may beidiopathic,familial/genetic,viral345and/or immune,67alcoholic/toxic, or associated with recognized

cardiovascular disease in which the degree of myocardial dysfunction is not

explained by the abnormal loading conditions or the extent of ischemic damage

(see below). Histology is nonspecific.
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CREB = cycl ic AMP response-element binding protein


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C. Costel, 35 ani


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Ecocardiografie

DTDVS=70 mm

DTSVS=55 mmFE=35%

Hipokinezie difuza

Valve, septuri = fara modificari patologice semnificative

Absenta lichidului pericardic, a maselor intracardiace

C. Costel, 35 ani


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AFECTAREA CARDIACA

MODIFICARI ECG

CARDIOMIOPATIE DILATATIVA

ARITMII


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MODIFICARI ECG

R inalt in V1 cu raport R/S > 1

Unde Q in precordialele stangi


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CARDIOMIOPATIA DILATATIVA

Prezenta la toate cazurile de la varsta de 18 ani

(afectarea infraclinica este prezenta de la varsta de 6 ani)

Forma clinica de CMD mai severa in varianta Becker-Kiener

Este cauza de deces la 10% din cazuri

Morfologic: fibroza miocardica (peretele VS postero-bazal +

parcelar sept, VD, AD)

Modificari degenerative ale sistemului de conducereCresterea eliminarilor de factor natriuretic atrial

Prolaps de valva mitrala


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ARITMII

Tahicardia sinusala sustinuta sau labila

Scurtarea intervalului PR

Aritmii supraventriculare si ventriculare variate

Blocuri AV


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Caz tipicde distrofie musculara Duchenne (varianta Becker-Kiener)

Debut in copilarie

Defic it muscular centura pelvina + evolutie spre centura scapulo-humerala

Pseudohipertrofie a gambei

Mers leganat

Hiperlordoza

Manevra Gowers* pozitiva

+


Pronostic rezervat

Indicatie de transplant cardiac

C. COSTEL, 35 ani


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Caz tipicde distrofie musculara Duchenne (varianta Becker-Kiener)

Debut in copilarie

Defic it muscular centura pelvina + evolutie spre centura scapulo-humerala

Pseudohipertrofie a gambei

Mers leganat

Hiperlordoza

Manevra Gowers* pozitiva

+


Pronostic rezervat

Indicatie de transplant cardiac

C. COSTEL, 35 ani


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TABLOU CLINIC

simptome [i semne

elemente anamnestice utile dgper exclusionem

DIAGNOSTIC

Radiografie toracic\Ecg

Ecocardiografia

Angiocardiografie nuclear\ sau RMN (IRM)

Cateterismul cardiac

Biopsia endomiocardic\


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B 47 ani


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9.10

B, 47 ani

Dg. clinic: Distrofie muscular\ progresiv\; CMD dilatativ\


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B 24 ani


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9.1

B, 24 ani

Dg. clinic: CARDIOMIOPATIE DILATATIV|


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Strategie1. Deoarece cardiomiopatia dilatativeste oboalterminalpentru diverse etiologii, n

consecini tratamentul nu are nimic specific.2. Cnd cauza este bine identificat,tratamentul etiologic urcpe primul loc.3. n final, tratamentul este identic cu cel al

insuficienei cardiace, indiferent de cauz.


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Tratament farmacologic

1. diuretice: spironolactona 100 - 200 mg pe zi (n funcie de severitateasindromului de retenie hidrosalin);

2. inhibitori ECA;3. betablocante: carvedilol 3,25 mg - 25 mg/zi, bisoprolol 2,5 - 10 mg/zi,

metoprolol 50 - 150 mg/zi;4. anticoagulantele: pot fi considerate ca utile la toi pacienii cu cardio-

miopatie dilatativ, n special la cei care asociaz i fibrilaie atrial (cure de 10-14zile cu heparin cu greutate molecular mic, urmate de preparate oraledicumarinice, pe termen nelimitat)

5. digitalicele se utilizeaz cu precauie sporit datorit riscului de intoxicaiedigitalic relativ, pe o fibr miocardic alungit de stresul tensiunii parietaleolul trebuie restricionat sever, pn la sevrage absolut;


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Tratament chirurgical

Tran sp lan t ca rd iac

Cardiomiopatii dilatative.pdf

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