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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.
http://www.besancon-cardio.net/pro/recommandations/classif_c.htmhttp://www.besancon-cardio.net/pro/recommandations/classif_c.htmhttp://www.besancon-cardio.net/pro/recommandations/classif_c.htmhttp://www.besancon-cardio.net/pro/recommandations/classif_c.htmhttp://www.besancon-cardio.net/pro/recommandations/classif_c.htmhttp://www.besancon-cardio.net/pro/recommandations/classif_c.htmhttp://www.besancon-cardio.net/pro/recommandations/classif_c.htmhttp://www.besancon-cardio.net/pro/recommandations/classif_c.htmhttp://www.besancon-cardio.net/pro/recommandations/classif_c.htmhttp://www.besancon-cardio.net/pro/recommandations/classif_c.htm8/14/2019 Cardiomiopatii dilatative.pdf
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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.
http://www.besancon-cardio.net/pro/recommandations/classif_c.htmhttp://www.besancon-cardio.net/pro/recommandations/classif_c.htmhttp://www.besancon-cardio.net/pro/recommandations/classif_c.htmhttp://www.besancon-cardio.net/pro/recommandations/classif_c.htmhttp://www.besancon-cardio.net/pro/recommandations/classif_c.htmhttp://www.besancon-cardio.net/pro/recommandations/classif_c.htmhttp://www.besancon-cardio.net/pro/recommandations/classif_c.htmhttp://www.besancon-cardio.net/pro/recommandations/classif_c.htmhttp://www.besancon-cardio.net/pro/recommandations/classif_c.htmhttp://www.besancon-cardio.net/pro/recommandations/classif_c.htm8/14/2019 Cardiomiopatii dilatative.pdf
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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
+
CARDIOMIOPATIE DILATATIVA
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
+
CARDIOMIOPATIE DILATATIVA
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
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