Other Cardiomyopathies

General¶

• 33% improve, 33% remain the same, 33% LV function deteriorates

Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA)¶

• Defined as acute myocardial infarction (MI) with angiographically no obstructive coronary artery disease or stenosis ≤ 50%
• CMR: Edema in coronary regional distribution pattern
  • Late gadolinium enhancement

Takotsubo Cardiomyopathy (TTS)¶

• Takotsubo cardiomyopathy: state-of-the-art review
• Update of Takotsubo cardiomyopathy: Present experience and outlook for the future
• Etiology
  • Primary
    • Idiopathic
    • Psych Stress
  • Secondary
    • Physical Stress
      • Asthma, Surgery, Severe Trauma
    • Drug-Induced
      • Catecholamine Stimulation (68.2% of drug-induced TTS cases)
        • Antiarrhythmics (Flecainide, Sotalol, Amiodarone, Lidocaine, Xylocaine)
      • Antidepressants
      • Chemotherapy (8.9%)
• Symptoms
  • Chest pain, sudden onset
• Labs
  • Troponin elevation mimicking acute MI
  • Check CRP/ESR
  • Check TSH/BNP
  • Consider r/o pheochromocytoma
• Diagnosis
  • ECG showing ST elevations
  • TTE: Apical ballooning with akinesis
  • LHC: Normal coronaries, needed to r/o CAD
  • CMR if no culprit lesion (gold-standard for determining myocardial status)
    • LV dysfunction in a noncoronary regional distribution pattern w/ + w/o RV involvement
    • Edema in NCRDP
    • Abscence of significant necrosis or fibrosis
    • Lack of any late gadolinium enhancement
  • InterTAK Diagnostic Score

    • 70 is high probability

  • Recovery of wMA on CMR within 2-6 months
    • Confirms Diagnosis
• Treatment
  • ACEI + BBs

Peripartum Cardiomyopathy (PPCM)¶

• RF: >30 y/o, Multiparity, AA, Multiple fetuses, Maternal cocaine use, Terbutaline (beta-agonist) use >4 weeks
• Uncommon cause of Dilated Cardiomyopathy
• Occurs anytime from week 26 through first 6 months postpartum
• Progressive dyspnea on exertion, lower extremity edema, 3^rd heart sound is suggestive of decompensated HF
• Often associated with mitral regurgitation (holosystolic murmur)
• Cardiomegaly, prominent vascular congestion, pleural effusions
• Symptoms
  • Heart failure, Dyspnea, cough, orthopnea, and peripheral edema
  • Onset of HF during last month of pregnancy or within 5 months following delivery (not seen before 36 weeks)
  • LV systolic dysfunction with LV ejection fraction <45%
  • Absence of causes of heart failure
  • Absence of heart disease prior to final month of pregnancy
• Diagnosis: TTE
• Prognosis
  • LVEF >30% at time of diagnosis is major predictor of persistent LV dysfunction
• Treatment
  • Same as HF unless Advanced HF or Unstable (delivery)
    • Not ACEI/ARBs
    • Loops > thiazides (fetal bleeding diathesis)
    • B1 selective
    • Avoid Digoxin

Tachycardia-Induced Cardiomyopathy¶

• Commonly due to Afib caused by structural changes in the heart
  • May also be due to atrial flutter, MAT, reentrant SVT, VT, and rarely frequent PVCs -Afib induced LV dysfunction
• Cardiomyopathy due to LV dilatation and dysfunction
• Symptoms
  • Palpitations
  • Progressive dyspnea, exercise intolerance, fatigue
• Exam
  • HR ≥120 for weeks/months
  • Can lead to myocardial cellular changes, LV dilation, impaired LV function
• Diagnosis: ECG or Ambulatory Holter
• W/U: TTE, testing to R/O MI
• Complications
  • Decompensated Heart Failure
• Treatment
  • Rate or rhythm control
    • Typically results in significant or complete LV function recovery over a period of months