9 cardiomiopatii
DESCRIPTION
curs cardiomiopatiiTRANSCRIPT
![Page 1: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/1.jpg)
Cardiomiopatiile
![Page 2: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/2.jpg)
Definitie
“Afectiune a miocardului asociata cu alterarea structurala si functionala a muschiului cardiac in absenta cardiopatiei ischemice, a hipertensiunii arteriale, a valvulopatiilor sau bolilor cardiace congenitale care sa explice afectarea miocardica.”
![Page 3: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/3.jpg)
Clasificare
• CMP Familiale: afecteaza mai multi membri ai unei familii
• CMP non-familiale: afecteaza un singur membru al unei familii – idiopatice/ dobandite (in cadrul altor afectiuni)
![Page 4: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/4.jpg)
Cardiomiopatia Dilatativa Idiopatica
![Page 5: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/5.jpg)
CMD - Definitie
• Sindrom caracterizat prin dilatare si disfunctie sistolica ventriculara stanga
• Dilatarea si disfunctia ventriculului drept pot fi prezente dar nu sunt obligatorii pentru diagnostic
In absenta unor conditii anormale de umplere VS (HTA, valvulopatii) sau a cardiopatiei ischemice cu disfunctie
contractila VS secundara !
![Page 6: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/6.jpg)
Incidenta• 5-8 cazuri / 100.000 locuitori / an
• De 3X mai frecvent la afro-americani si la sexul masculin decat la caucazieni si respectiv sexul feminin
• CMD simptomatica – 10 - 50% mortalitate la 1 an
• Rata anuala a mortalitatii 11-13%
• 25% din pacientii cu CMD cu debut recent se pot ameliora spontan
![Page 7: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/7.jpg)
Supravietuirea observata in cadrul unui lot de 104 pacienti
104
72
56 5145
37 35 3124 19 16
0
20
40
60
80
100
120
0 1 2 3 4 5 6 7 8 9 10
YearsAm J Cardiol 1981; 47:525
Cardiomiopatia dilatativa idiopatica
![Page 8: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/8.jpg)
CMD – Anatomie patologica
• Dilatarea celor 4 camere cardiace
• Ventriculi > atrii
• Trombi intracavitari
Histologie
• Arii de fibroza interstitiala si perivasculara
• Miocite hipertrofice / atrofiate
• Nu exista markeri imunologici, histochimici, morfologici, ultrastructurali sau microbiologici specifici !
![Page 9: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/9.jpg)
CMD – Etiologie
1. Genetica si familiala 2. Virala/Citotoxica 3. Imunologica
Proteine ale sarcomerului:Lanturi grele de ß miozinaLanturi usoare de miozinaLanturi reglatoare de miozinaActinaTroponina TTroponina IAlfa-tropomiozinaProteina C care leaga miozinaBanda ZProteine citoscheletale:DistrofinaDesminaMetavinculinaMembrana nucleara:LamininaEmerina
![Page 10: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/10.jpg)
Tablou clinic
• Debut simptomatic la subiecti de varsta medie (B>F)
• Simptomele apar de obicei progresiv
• Dialatarea ventriculara precede uneori aparitia simptomelor
• Debut acut dupa un episod infectios viral
![Page 11: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/11.jpg)
Simptome si semne de IC
• Simptome de insuficienta cardiaca:– congestie pulmonara
dispnee (repaus, efort, nocturna), ortopnee– congestie sistemica
greata, dureri abdominale, nicturie– debit cardiac scazut
fatigabilitate, slabiciune musculara
![Page 12: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/12.jpg)
Examen fizic
Semne de insuficienta cardiaca• hipotensiune, tahicardie, tahipnee, turgescenta jugulara• hepatomegalie pulsatila• edeme periferice• ascita• embolii sistemice
• AMC crescute in sens transversal
• Impuls apical deplasat lateral
• Zg3, Zg4
• Zg 2 dedublat (HTP)
• Suflu sistolic de regurgitare mitrala/tricuspidiana
![Page 13: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/13.jpg)
Examinari de laborator
• ECG• Rx cardio-pulmonara• Holter ECG (ameteala, palpitatii, sincope)• Ecocardiografie• Cateterism cardiac
![Page 14: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/14.jpg)
Factori cu rol prognostic in CMD
Clinici Neinvazivi Invazivi
Clasa NYHA III/IV FE scazuta Presiuni de umplere
Varsta avansata Dilatare VS marcata
Cons. O2 ↓ la efort Masa VS ↓(<10-12ml/kg/min)
TCIV importante RM > moderata Aritmii ventriculare Disfunctie diastolicacomplexe
Semne de stimulare Rezerva contractila scazutasimpatica excesiva
Galop protodiastolic Dilatare sau disfunctie de VD
![Page 15: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/15.jpg)
Managementul CMD
• Limitarea activitatii in functie de statusul functional• Restrictie sodata 2-g Na+ (5g NaCl) • Restriction de fluide in caz de hiponatremii severe • Tratament medicamentos:
– Betablocante– ACE inhibitori– Diuretice de ansa– Spironolactona– Combinatii de hidralazina / nitrati– Digoxin– Anticoagulant (FE< 30%, trombi intracavitari, istoric de
tromboembolism periferic, Fia)– dopamina, dobutamina si/sau inhibitori de fosfodiesteraza iv
![Page 16: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/16.jpg)
Managementul CMD
•Tratament imunosupresiv
•Resincronizare
•Tratament chirurgical (valva mitrala, remodelare VS)
•Dispozitive de asistare ventriculara
•Transplant cardiac
![Page 17: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/17.jpg)
Indicatii clinice ale biopsiei endomiocardice
1. IC cu debut recent < 2 sapt asociata cu dilatare ventriculara si compromitere hemodinamica (I)
2. IC cu debut intre 2 sapt si 3 luni asociata cu dilatare ventriculara si aritmii ventriculare nou aparute, BAV II, III si lipsa de raspuns la masurile terapeutice uzuale (I)
![Page 18: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/18.jpg)
Cardiomiopatia hipertrofica (CMH)
![Page 19: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/19.jpg)
Cardiomiopatia hipertrofica
• Prevalenta 0.02 - 0.2%
• Ventricul stang hipertrofiat si nedilatat, in absenta altor cauze de HVS (disfunctie predominant diastolica)
• Cavitate VS mica, HVS asimetrica, miscarea sistolica anterioara a valvei mitrale (SAM)
![Page 20: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/20.jpg)
Sept si perete anterolateral VS - frecvent Perete posterobazal - rar
![Page 21: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/21.jpg)
CMH - Histologie
• Hipertrofie miocitara
• Dezorganizare miocitara – “disarray” > 5% din miocard
![Page 22: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/22.jpg)
CMH - Fiziopatologie
•Sistola– Gradient dinamic in tractul de golire al VS
•Diastola– Alterarea umplerii diastolice, presiunii de
umplere, dilatare atriala importanta
•Ischemie miocardica masei musculare, presiunilor de umplere, cons.
O2 rezerva vasodilatorie, densitatea capilara– Compresie sistolica a coronarelor intramurale
![Page 23: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/23.jpg)
valva mitrala
in pozitie
normala
CMH
![Page 24: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/24.jpg)
Valva mitrala vine in
contact cu septul in sistola
MR
CMH
![Page 25: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/25.jpg)
hipetrofie simetrica
sau concentrica
CMH
![Page 26: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/26.jpg)
Cavitate reziduala
mica
Hipetrofie apicala
CMH
![Page 27: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/27.jpg)
CMH Familiala
• Transmitere autosomal dominanta in 50% din cazuri
• 10 gene diferite ale prot. sarcomerice cu peste 150 de mutatii
• Lantui grele de beta miozina
• Lanturi usoare de miozina
• Lanturile reglatoare ale miozinei
• Actina
• Troponina T
• Troponina I
• Alfa-tropomiozina
• Proteina C care leaga miozina
![Page 28: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/28.jpg)
CMH - Tablou clinic
• Asimptomatic, descoperire ecocardiografica• MS poate reprezenta prima manifestare• Simptomatic – adulti 40-50 ani
– dispnee - 90%– angina pectoris - 75%– fatigbilitate, pre-sincopa, sincopa
risc de MS la opii si adolescenti– palpitatii, DPN, IC – rar– efortul accentueaza simptomele
![Page 29: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/29.jpg)
CMH - Examen fizic
• Impuls apical sustinut
• Zg 4 (contractie atriala viguroasa)
• Unda a proeminenta – puls venos jugular
• Suflu sistolic aspru crescendo- descrescendo care incepe dupa Zg 1 si se ausculta intre apex si marginea stanga a sternului (nu iradiaza pe vasele gatului)
![Page 30: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/30.jpg)
Manevre care ↑ gradientul si suflul
Contractilitate Presarcina PostsarcinaValsalva (strain) --- Standing --- --Postextrasistolic -- isoproterenol Digitala --Nitrit de amil -- Nitroglicerina --- Efort Tachicardie -- Hipovolemie
![Page 31: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/31.jpg)
Manevre care ↓ gradientul si suflul
Contractilitate Presarcina Postsarcina
Manevra Mueller --- Valsalva (overshoot) --- Squatting --- Ridicarea pasiva a picioarelor --- -Fenilefrina --- -- Beta-blocantele -- Anestezia generala -- --Efortul izometric --- --
![Page 32: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/32.jpg)
CMH vs Stenoza Aortica
CMH Obstructie fixapuls carotidian “spike and dome” “parvus et tardus”
suflu radiat pe carotide valsalva, standing squatting, handgrip passive leg elevation
tril sistolic sp IV ic stang sp II ic drept clic sistolic absent prezent
![Page 33: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/33.jpg)
CMH - Laborator
• ECG normal – 15-25%
• HVS
• Corelatie slaba intre HVS pe ECG si la ecocardiografie
• Unde T gigante negative – CMH apical (japonezi)
•Q DII,III,aVF, V2-6Aritmii supraventriculare – Fia
Aritmii ventriculare TVNS, TV
Rx, ECG, Holter ECG, SEF
![Page 34: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/34.jpg)
CMH - Ecocardiografie
SIV si/sau PP > 15 mm → 60 mm
VMA lunga proemina in TEVS
![Page 35: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/35.jpg)
![Page 36: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/36.jpg)
Istoria naturala
• mortalitate anuala 3% in centrele tertiare, probabil 1% in general
• risc de MS mare la copii → 6%/an
• deterioare clinica lenta
• progresie spre CMD in 10-15% din cazuri
![Page 37: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/37.jpg)
Factori de risc pentru MS
• Istoric de MS (FV) Istoric familial de MS
• TVS• Istoric de sincope• Magnitudinea HVS > 30 mm• Raspuns TA anormal laefort• TVNS (Holter)
• FiA
• Ischemia miocardica
• Obstructie TEVS
• Mutatii cu risc crescut
• Sportul competitiv
Majori Posibili
![Page 38: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/38.jpg)
Recomandari pentru activitate competitionala
• Evitarea sporturilor competiotionale indiferent daca exista sau nu gradient dinamic
![Page 39: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/39.jpg)
CMH - Management
• Betablocante (Metoprolol) – prima linie
efect inotrop si cronotrop negativ
scad consumul miocardic de O2
amelioreaza umplerea diastolica
reduc severitatea anginei si efectele negative ale obstructiei TEVS
• Blocante de calciu (Verapamil, Diltiazem) – in caz de ineficienta sau intoleranta a medicatiei BB
• efect inotrop si cronotrop negativ• amelioreaza umplerea diastolica
Atentie: Efect vasodilatator impredictibil, precautie in CMHO!
![Page 40: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/40.jpg)
• Disopiramida – agent antiaritmic de clasa IA- alternativa la BB sau CCB
inotrop negativsuprima aritmiile ventriculareutila in CMHO
• Amiodarona, sotalol
• Miotomie – miectomie (procedura Morrow)• Ablatia septala prin alcoolizare• Plicaturarea VMA• DDD pacing
CMH - Management
![Page 41: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/41.jpg)
CMH vs cordul atletului
CMH Atlet+ Patern particular HVS -+ Cavitatea VS <45 mm -- Cavitatea VS >55 mm ++ Dilatarea AS -+ Patern ECG bizar -+ Anomalii umplere VS - + Sex F -- HVS cu deconditionarea ++ Istoric familial de CMH -
Circulation 1995; 91:1596
![Page 42: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/42.jpg)
Cardiomiopatia restrictiva
![Page 43: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/43.jpg)
Cardiomiopatia restrictiva
• Trasatura definitorie: disfunctia diastolica
• Pereti ventriculari rigizi
• Functie sistolica pastrata
• Asemanari cu pericardita constrictiva (potential tratabila)
![Page 44: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/44.jpg)
Clasificare• Idiopatica
• Miocardica
1. Noninfiltrativa
– Idiopatica
– Scleroderma
2. Infiltrativa
– Amiloid
– Sarcoid
– B. Gaucher
– B. Hurler
3. B. de stocare
– Hemocromatoza
– B. Fabry
– Stocarea glicogenului
• Endomiocardica
– fibroza endomiocardica
– Sd. Hipereozinofilic
– Sd. carcinoid
– metastaze
– radiatii, antracicline
![Page 45: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/45.jpg)
Tablou clinic
• Simptome de IC dreapta si stanga
• Puls venos jugular – Curbe x si y proeminente
• Echo-Doppler– pattern mitral anormal– E ampla (umplere diastolica rapida)– TDE scurt (presiune AS crescuta)
![Page 46: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/46.jpg)
Pattern Constrictiv - Restrictiv “Square-Root Sign” sau “Dip-and-Plateau”
![Page 47: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/47.jpg)
PTDVS > PTDVD (cu cel putin 5 mmHg)
PAPs > 50 mmHg
Platoul PTDVD < 1/3 dinPAPs
Cateterism cardiac
![Page 48: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/48.jpg)
![Page 49: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/49.jpg)
![Page 50: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/50.jpg)
![Page 51: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/51.jpg)
Imunofixarea Amiloidoză primară cu lanţuri uşoare λ de Ig G
![Page 52: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/52.jpg)
Aspirat din grAspirat din grăăsimea subcutanatsimea subcutanatăă abdominal abdominalăă – – coloracoloraţţie Roie Roşşu de Congo- depozite de amiloidu de Congo- depozite de amiloid
![Page 53: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/53.jpg)
Restrictie vs Constrictie
• Pericardita constrictiva • istoric de TBC, traumatism, pericarditia,
colagenoze• Cardiomiopatia restrictiva
– amiloidoza, hemocromatoza
• Mixed– Iradiere mediastinala, chirurgie cardiaca
![Page 54: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/54.jpg)
Criterii de diagnostic diferenţial ecografic între pericardita constrictivă şi cardiomiopatia restrictivă
Pericardita constrictivă Cardiomiopatia restrictivă
2D - îngroşare pericardică, revărsat pericardic
- dimensiuni normale de pereţi
- deplasare abruptă a SIV
- dilatare biatrială
- ventriculi de dimensiuni normale
- hipertrofie de SIV, SIA
- aspect neomogen al miocardului
Doppler mitral - modificări respiratorii - fără modificări respiratorii
Velocităţi inel mitral Doppler tisular (E’)
- >8 cm/s - <8 cm/s ( 3 cm/s )
PAPS - < 50 mmHg - > 50 mmHg ( 65 mmHg )
![Page 55: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/55.jpg)
Tratament
• Nu exista terapie eficienta– diuretice pt presiuni de umplere f mari– vasodilatoare– ? Blocantele de calciu pt ameliorarea
compliantei diastolice – digitala si alti agenti inotropi nu sunt indicati
– In cazul amiloidozei – agenti alchilanti
![Page 56: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/56.jpg)
Displazia aritmogena de ventricul drept
![Page 57: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/57.jpg)
Criteria Major Minor
Family History Familial disease confirmed at necropsy or surgery
Family history of premature sudden death (<35 years) caused be suspected ARVD
Family history of ARVD
ECG depolarization/conduction abnormalities
Epsilon waves or prolongation of the QRS complex ( ≥ 110 msec) in the right precordial leads ( V1 – V3)
Late potentials seen on signal averaged ECG
Repolarization abnormalities Inverted T waves in the right precordial leads in patients > 12 in the absence of right bundle branch block
Tissue characterization of walls Fibrofatty replacement of myocardium on endomyocardial biopsy.
Global or regional dysfunction and structural alterations
Severe dilation and reduction of RV ejection fraction with minimal LV involvement
Mild global RV dilation or ejection fraction reduction with normal LV
Localized RV aneurysms Mild segmental dilation of the RV
Severe segmental dilation of the RV Regional RV hypokinesia
Arrhythmia Left bundle branch lack type ventricular tachycardia (sustained and nonsustained)(ECG, Holter, exersise testing)
Frequent ventricular extrasystoles (more than 1,000/24 h) (Holter).
![Page 58: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/58.jpg)
![Page 59: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/59.jpg)
Younger patients Patients who present with recurrent syncope Patients with history of cardiac arrest or sustained VT Patients with clinical signs of RV failure Patients with LV involvement Patients with or having a family member with the high risk ARVD gene (ARVD2) Patients with an increase in QRS dispersion ≥ 40 msec (maximum measured QRS duration minus minimum measured QRS duration) Patients with Naxos disease
High Risk Features in Patients with ARVD
![Page 60: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/60.jpg)
Noncompactarea VS
![Page 61: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/61.jpg)
![Page 62: 9 Cardiomiopatii](https://reader036.vdocuments.mx/reader036/viewer/2022081421/55cf9020550346703ba31c74/html5/thumbnails/62.jpg)
• Pacientii cu risc scazut (>30 ani) pot participa la activitati competitive in absenta:– TV Holter– Istoric familial de MS cauzata de CMH– Istoric de sincopa – Anomalii hemodinamice, gradient 50 mmHg– hipoTA la efort– Regurgitare mitrala moderata/severa– AS dilatat (50 mm)– Fia paroxistica– Anomalii de perfuzie miocardica
Recomandari pentru activitate competitionala