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CURSURI CARDIOLOGIE
Pentru
STUDENTI & MEDICI
2012-2013
Conf. Dr. Ioan BostacaUniversitatea de MedicinGr.T.Popa IASI
CURS 9/29 X 2012
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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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Hypertensive cardiomyopathyoften presents with left ventricular hypertrophy in
association with features of dilated or restrictive cardiomyopathy with cardiac failure.
Inflammatory cardiomyopathyis defined by myocarditis in association with cardiac
dysfunction. Myocarditis is an inflammatory disease of the myocardium and isdiagnosed by established histological, immunological, and immunohistochemical
criteria. Idiopathic, autoimmune, and infectious forms of inflammatory
cardiomyopathy are recognized. Inflammatory myocardial disease is involved in the
pathogenesis of dilated cardiomyopathy and other cardiomyopathies, eg, Chagas'
disease, HIV, enterovirus, adenovirus, and cytomegalovirus.13
Metabolic cardiomyopathyincludes the following categories: Endocrine, eg,thyrotoxicosis, hypothyroidism, adrenal cortical insufficiency, pheochromocytoma,
acromegaly, and diabetes mellitus; familial storage disease and infiltrations, eg,
hemochromatosis, glycogen storage disease, Hurler's syndrome, Refsum's
syndrome, Niemann-Pick disease, Hand-Schller-Christian disease, Fabry-Anderson
disease, and Morquio-Ullrich disease; deficiency, eg, disturbances of potassium
metabolism, magnesium deficiency, and nutritional disorders such as kwashiorkor,anemia, beri-beri, and selenium deficiency; amyloid, eg, primary, secondary, familial,
and hereditary cardiac amyloidoses, familial Mediterranean fever, and senile
amyloidosis.
Report of the 1995 World Health
Organization/International Society and Federation ofCardiology Task Force on the Definition and
Classification of Cardiomyopathies
http://www.besancon-cardio.net/pro/recommandations/classif_c.htmhttp://www.besancon-cardio.net/pro/recommandations/classif_c.htm8/14/2019 cardiomiopatii CLASIFICARI NONCOMPACT TAKOTSUBO.pdf
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Hypertensive cardiomyopathyoften presents with left ventricular hypertrophy in
association with features of dilated or restrictive cardiomyopathy with cardiac failure.
Inflammatory cardiomyopathyis defined by myocarditis in association with cardiac
dysfunction. Myocarditis is an inflammatory disease of the myocardium and isdiagnosed by established histological, immunological, and immunohistochemical
criteria. Idiopathic, autoimmune, and infectious forms of inflammatory
cardiomyopathy are recognized. Inflammatory myocardial disease is involved in the
pathogenesis of dilated cardiomyopathy and other cardiomyopathies, eg, Chagas'
disease, HIV, enterovirus, adenovirus, and cytomegalovirus.13
Metabolic cardiomyopathyincludes the following categories: Endocrine, eg,thyrotoxicosis, hypothyroidism, adrenal cortical insufficiency, pheochromocytoma,
acromegaly, and diabetes mellitus; familial storage disease and infiltrations, eg,
hemochromatosis, glycogen storage disease, Hurler's syndrome, Refsum's
syndrome, Niemann-Pick disease, Hand-Schller-Christian disease, Fabry-Anderson
disease, and Morquio-Ullrich disease; deficiency, eg, disturbances of potassium
metabolism, magnesium deficiency, and nutritional disorders such as kwashiorkor,anemia, beri-beri, and selenium deficiency; amyloid, eg, primary, secondary, familial,
and hereditary cardiac amyloidoses, familial Mediterranean fever, and senile
amyloidosis.
http://www.besancon-cardio.net/pro/recommandations/classif_c.htmhttp://www.besancon-cardio.net/pro/recommandations/classif_c.htm8/14/2019 cardiomiopatii CLASIFICARI NONCOMPACT TAKOTSUBO.pdf
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General system disease includes connective tissue
disorders, eg, systemic lupus erythematosus, polyarteritis
nodosa, rheumatoid arthritis, scleroderma, and
dermatomyositis. Infiltrations and granulomas include
sarcoidosis and leukemia.Muscular dystrophies include Duchenne, Becker-type,
and myotonic dystrophies.
Neuromuscular disorders include Friedreich's ataxia,
Noonan's syndrome, and lentiginosis.Sensitivity and toxic reactions include reactions to
alcohol, catecholamines, anthracyclines, irradiation, and
miscellaneous.
Alcoholic cardiomyopathy may be associated with a heavy
alcohol intake. At present we cannot define a causal versus a
conditioning role of alcohol or apply precise diagnostic
criteria.
Peripartal cardiomyopathy may first manifest in the
peripartum period. This is probably a heterogeneous group.
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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General system disease includes connective tissue
disorders, eg, systemic lupus erythematosus, polyarteritis
nodosa, rheumatoid arthritis, scleroderma, and
dermatomyositis. Infiltrations and granulomas include
sarcoidosis and leukemia.Muscular dystrophies include Duchenne, Becker-type,
and myotonic dystrophies.
Neuromuscular disorders include Friedreich's ataxia,
Noonan's syndrome, and lentiginosis.Sensitivity and toxic reactions include reactions to
alcohol, catecholamines, anthracyclines, irradiation, and
miscellaneous.
Alcoholic cardiomyopathy may be associated with a heavy
alcohol intake. At present we cannot define a causal versus a
conditioning role of alcohol or apply precise diagnostic
criteria.
Peripartal cardiomyopathy may first manifest in the
peripartum period. This is probably a heterogeneous group.
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Clasificarea CARDIOMIOPATIILOR (dup OMS, 1996)
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CLASIFICARE CLASIC
1. cardiomiopatii dilatative;2. cardiomiopatii hipertrofice (cu obstruc]ie sau f\r\
obstruc]ie): cardiomiopatia hipertrofic\ obstructiv\; cardiomiopatia hipertrofic\ neobstructiv\;
3. cardiomiopatia restrictiv\.
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CLASIFICARE(minimal, elementar)
Dilatativ\
Hipertrofic\
Restrictiv\
CM (displazia) aritmogen\ a VD
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DIMENSIUNI NORMALE CMD
CMH CMR
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Clasificarea CARDIOMIOPATIILOR (etiopatogenic) dup AHA
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Clasificarea CARDIOMIOPATIILOR (etiopatogenic) dup AHA
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ESC, Working Group on myocardial and pericardial diseases, 2008
Clasificare etiologic\:
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Clasificare etiologic\:A. Cardiomiopatii dilatative primitive (idiopatice).B. Cardiomiopatii dilatative secundare: cardiomiopatii inflamatorii:
infec]ioase (virusuri, bacterii, fungi); neinfec]ioase (colagenoze, granulomatoze).
cardiomiopatii nutri]ionale: avitaminoza B1; pelagra; scorbutul; deficitul de seleniu.
cardiomiopatii din boli endocrine [i metabolice: diabet zaharat (cardiomiopatia diabetic\); uremie (cardiomiopatia uremic\); tireotoxicoza (cardiotireoza); mixedem; feocromocitom (cardiomiopatia adrenergic\); acromegalia;
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Tablou clinicSimptomatologia se dezvolt\ lent, cu manifest\ri progresive de insuficien]\ cardiac\
stng\ [i dreapt\:
simptome de insuficien]\ cardiac\ stng\: dispnee, oboseal\, sl\biciunemuscular\. semne de insuficien]\ cardiac\ dreapt\:edeme;hepatomegalie;jugulare turgescente.Alte semne [i simptome: tahicardie sinusal\; sufluride insuficien]\ mitral\ sau tricuspidian\ (organo-func]ionale); galop atrial, ventricular sau de suma]ie.
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Alte elemente clinice sugestive pentru cardiomiopatie dilatativ\ primitiv\
(idiopatic\): existen]a n antecedentele pacientului a unor frecvente st\ri gripale
(miocardit\ cronic\); formare de trombusuri intracavitare, ce favorizeaz\ apari]ia emboliilor (siste-
mice sau pulmonare); comportamentul refractarla tratamentul clasic al insuficien]ei cardiace; vulnerabilitatea miocardului la tratamentul cu digital\, realiznd rapid
manifest\ri de intoxica]ie digitalic\ relativ\ (uneori aritmii amenin]\toare pentru
via]\),nainteaob]inerii efectului terapeutic scontat prin digitalizare optimal\.
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Explor\ri paraclinice1. Electrocardiogramaarat\ modific\ri nespecifice: tahicardie sinusal\; tulbur\ri de ritm ectopice: fibrila]ie atrial\; aspect de Q sau QS nderiva]iile V1-V4 sau nV5-V6
(aspect pseudo-infarct); anomalii ale segmentului ST [i ale undei T: subdenivelare de ST [i und\
T negativ\; tulbur\ri de conducere:
bloc de ram stng;blocuri atrio-ventriculare.
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2. Radiografia toracic\relev\:
cardiomegalie (ICT peste 0,55); staz\ venoas\ pulmonar\; radiografiile seriate arat\ progresia (evolu]ia natural\ defavorabil\) sau
regresia ICT (amelior\ri pasagere).
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3.Ecocardiografia: exclude alt\ boal\ ce evolueaz\ cu cardiomegalie; determin\ gradul de afectare a func]iei sistolice ventriculare; poate urm\ri ntimp evolu]ia bolii.
Modific\rile ecocardiografice sugestive pentru cardiomiopatie
dilatativ\ sunt:
hipokinezia difuz\ mai mult sau mai pu]in sever\; pere]i sub]iri; m\rirea diametrelor camerelor ventriculare; trombusuri intracavitare.
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Caracteristice pentru sc\derea debitului cardiacsunt: deschiderea limitat\ a valvei mitrale n diastol\,datorit\ unui flux transmitral sc\zut nchiderea sistolic\ incomplet\ a valvei mitrale
datorit\ cre[terii necorespunz\toare a presiunii dinventriculul stng; nchiderea precoce a valvei aortice datorit\
sc\derii ejec]iei ventriculului insuficient.Determin\ri Eco-cantitative privind performan]acardiac\: m\surarea frac]iei de ejec]ie;
m\surarea frac]iei de scurtare; eviden]ierea regurgita]iei mitrale sau
tricuspidiene.
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4.Angiocardiografia nuclear\, RMN (IRM)
- debitul cardiac,- frac]ia de ejec]ie, frac]ia de scurtare (cu o preciziemai mare dectecocardiografia)
5. Scintigrafia miocardic\efectuat\ cu diferite substan]eradiofarmaceutice poate exclude cardiopatia ischemic\.6.Cateterismul cardiacpoate determina, nplus,- presiunile telediastolice ventriculare, utile n
aprecierea disfunc]iei ventriculilor.- angiografia coronarian\ este normal\ (exclude
cardiomiopatia ischemic\ cu insuficien]\ cardiac\)
7. Biopsia endomiocardic\ este util\ n confirmareaunor boli specifice miocardice, cum ar fi sarcoidoza sauhemocromatoza.
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Report of the 1995 World Health
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Specific ardiomyopathies
Definition and lassificationSpecific ardiomyopathies
References
The term specific cardiomyopathies is now used to describe heartmuscle diseases that are
associated with specific cardiac orsystemic disorders. These were previously defined as specificheart
muscle diseases.
Ischemic cardiomyopathypresents as a dilated cardiomyopathywith impaired contractile performancenot explained by the extentof coronary artery disease or ischemic damage.
Valvular cardiomyopathypresents with ventricular dysfunctionthat is out of proportion to the abnormal
loading conditions.
Report of the 1995 World Health
Organization/International Society and Federation of
Cardiology Task Force on the Definition and
Classification of Cardiomyopathies
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.htm8/14/2019 cardiomiopatii CLASIFICARI NONCOMPACT TAKOTSUBO.pdf
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