复旦大学：《内科学 Internal Medicine MBBS》课程教学资源（课件讲稿）循环系统_Cardiomyopathy and Myocarditis

CHAPTER 18 CARDIOMYOPATHY AND MYOCARDITIS Cui jie Department of cardiology Zhongshan Hospital, Fudan University Shanghai Institute of Cardiovascular Diseases

Cui Jie Department of Cardiology Zhongshan Hospital, Fudan University

Acquired heart diseases Coronary Hypertension Valvular heart disease Primary heart diseases Shanghai Institute of Cardiovascular Diseases

 Coronary  Hypertension  Valvular heart disease Primary heart diseases

Definition e The cardiomyopathies are a group of diseases that affect the heart muscle itself and are NoT the result of hypertension or congenital or acquired valvular, coronary, or pericardIa abnormalities Shanghai Institute of Cardiovascular Diseases

 The cardiomyopathies are a group of diseases that affect the heart muscle itself and are NOT the result of hypertension or congenital or acquired valvular, coronary, or pericardial abnormalities

PRIMARY CARDIOMYOPATHIES (predominantly involving the heart Genetic Mixed Acquired HCM DCM Inflammatory ( myocarditis ARVD/C Restrictive Stress-provoked (non-hypertrophied(tako-tsubo") LVNC and non-dilated) Peripartum PRKAG2\ Glycogen Tachycardia-induced Danon/storage Conduction defects Infants of insulin-dependent diabetic mothers Mitochondrial myopathies lon channel disorders LQTS Brugada SQTS CVPT Asian SUNDS

Ao Ao Normal Dilated cardiomyopathy Ao Ao Hypertrophic cardiomyopathy Restrictive cardiomyopathy Copyright @2006 by The McGraw-Hill Companies, Inc. All rights reserved

DILATED CARDIOMYOPATHY Shanghai Institute of Cardiovascular Diseases

Dilated Cardiomyopathy Normal Heart Dilated Cardiomyopathy Dilation Dysfunction Differentiation Shanghai Institute of Cardiovascular Diseases

Dilated Cardiomyopathy Dilation Dysfunction Differentiation

Shanghai Institute of Cardiovascular Diseases

Symptoms Associated With Heart Failure Fatigue Shortness of breath(at rest or during exercise Dyspnea, paroxysmal nocturnal dyspnea, orthopnea Weight gain or weight loss Edema(of the extremities or elsewhere) Exclude ischemic, valvular, hypertensive, metabolic cardiomyopathy D。 Shanghai Institute of cardiovascular Diseases

Fatigue Shortness of breath (at rest or during exercise) Dyspnea, paroxysmal nocturnal dyspnea, orthopnea Weight gain or weight loss Edema (of the extremities or elsewhere) Exclude ischemic, valvular, hypertensive, metabolic cardiomyopathy …

Physical examination Cardiac dullness enlargement Apical impulse displaced leftward or inferiorly Sa or Sa, gallop(tachycardia) Murmurs of tricuspid or mitral regurgitation Pulmonary congestion Systemic congestion e tachypnea Engorgement of jugular vein Dullness and diminished Hepatomegaly, ascites breath sounds at lung bases Pedal edema Rales Shanghai Institute of Cardiovascular Diseases

Cardiac dullness enlargement Apical impulse displaced leftward or inferiorly S3 or S4 , gallop (tachycardia) Murmurs of tricuspid or mitral regurgitation Pulmonary congestion • Tachypnea • Dullness and diminished breath sounds at lung bases • Rales Systemic congestion • Engorgement of jugular vein • Hepatomegaly, ascites • Pedal edema