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67. Niemann JT, Bessen HA, Rothstein RJ, et al. Electrocardiographic criteria for tricyclic antidepressant cardiotoxicity. Am J Cardiol 1986 May 1;57(13):1154-1159. (Comparative; 25 patients) ++

Cardiomyopathy versus discreet heart muscle disease

dilated cardiomyopathy hypertrophic cardiomyopathy restrictive cardiomyopathy arrhythmogenic right ventricular cardiomyopathy

idiopathic left and/or right ventricular hypertrophy restrictive filling and reduced diastolic volume of either or both ventricles progressive fibfrofatty replacement of the right ventricular myocardium

familial/genetic usually assymetric and involving the iv septum normal or near-normal systolic function and wall thickness septum relatively spared

viral and/or immune LV volume typically normal or reduced (i.e. non dilated increase interstitial fibrosis may be present Familial disease is common with autosomal dominant inheritance and incomplete penetrance

alcoh/toxic systolic gradients are common idiopathic or associated with other disease such as amyloidosis; endomyocardial disease with or without eosinophilia

assoc with recognized cv disease in which the degree of myodardial dysfunction is not explained by the abnormal loading conditions or the extent of ischemic damage Familial disease with autosomal dominant inheritance predominates

histology non specific mutations in sarcomeric contractile protein genes cause disease

presents with CHF often progressive Typical morphological changes include myocyte hypertrophy and disarray surrounding areas of increased loose connective tissue. Presentation with arrhythmia and sudden death is common especially in the young

Arrhythmias Arrhythmias

thromboembolism

sudden death Sudden death Unclassified Cardiomyopathies
Unclassified cardiomyopathies include a few cases that do not fit readily into any group (eg, fibroelastosis, noncompacted myocardium, systolic dysfunction with minimal dilatation, mitochondrial involvement).

Specific Cardiomyopathies

these were previousl defined as specific heart muscle diseases

Ischemic cardiomyopathy presents as dilated cardiomyopathy impaired contractile performance not explained by extent of coronary a. disease or ischemic damage

Valvular cardiomyopathy presents with ventricular dysfunction out of proportion to the abnormal loading conditions

Hypertensive cardiomyopathy LVH, Dilated or Restricted with Failure

Inflammatory cardiomyopathy myocarditis in association with cardiac dysfunction: idiopathic, autoimmune, infectious: Chagas disease, HIV, enterovirus, adenovirus, cytomegalovirus.

Metabolic cardiomyopathy Metabolic cardiomyopathy includes 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-Schüller-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.

General System Disease connective tissue disorders such as sle, polyarteritis nodosa, RA, Sclerodermn, dermatomyositis. Infiltrations and gramulomas such as sarcoidosis and leukemia

Muscular dystrophies Duchenne, Becker-type and myotonic dystrophies

Neuromuscular disorders Noonan's Syndrome Friedreich's ataxia, lentiginosis

sensitivity and toxic reactions alcohol, catecholamines, anthracyclines, radiation, misc.

Peripartal cardiomyopathy

dilated cardiomyopathy	hypertrophic cardiomyopathy	restrictive cardiomyopathy	arrhythmogenic right ventricular cardiomyopathy
idiopathic	left and/or right ventricular hypertrophy	restrictive filling and reduced diastolic volume of either or both ventricles	progressive fibfrofatty replacement of the right ventricular myocardium
familial/genetic	usually assymetric and involving the iv septum	normal or near-normal systolic function and wall thickness	septum relatively spared
viral and/or immune	LV volume typically normal or reduced (i.e. non dilated	increase interstitial fibrosis may be present	Familial disease is common with autosomal dominant inheritance and incomplete penetrance
alcoh/toxic	systolic gradients are common	idiopathic or associated with other disease such as amyloidosis; endomyocardial disease with or without eosinophilia
assoc with recognized cv disease in which the degree of myodardial dysfunction is not explained by the abnormal loading conditions or the extent of ischemic damage	Familial disease with autosomal dominant inheritance predominates
histology non specific	mutations in sarcomeric contractile protein genes cause disease
presents with CHF often progressive	Typical morphological changes include myocyte hypertrophy and disarray surrounding areas of increased loose connective tissue.		Presentation with arrhythmia and sudden death is common especially in the young
Arrhythmias	Arrhythmias
thromboembolism
sudden death	Sudden death		Unclassified Cardiomyopathies Unclassified cardiomyopathies include a few cases that do not fit readily into any group (eg, fibroelastosis, noncompacted myocardium, systolic dysfunction with minimal dilatation, mitochondrial involvement).

Specific Cardiomyopathies	these were previousl defined as specific heart muscle diseases
Ischemic cardiomyopathy	presents as dilated cardiomyopathy impaired contractile performance not explained by extent of coronary a. disease or ischemic damage
Valvular cardiomyopathy	presents with ventricular dysfunction out of proportion to the abnormal loading conditions
Hypertensive cardiomyopathy	LVH, Dilated or Restricted with Failure
Inflammatory cardiomyopathy	myocarditis in association with cardiac dysfunction: idiopathic, autoimmune, infectious: Chagas disease, HIV, enterovirus, adenovirus, cytomegalovirus.
Metabolic cardiomyopathy	Metabolic cardiomyopathy includes 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-Schüller-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.
General System Disease	connective tissue disorders such as sle, polyarteritis nodosa, RA, Sclerodermn, dermatomyositis. Infiltrations and gramulomas such as sarcoidosis and leukemia
Muscular dystrophies	Duchenne, Becker-type and myotonic dystrophies
Neuromuscular disorders	Noonan's Syndrome Friedreich's ataxia, lentiginosis
sensitivity and toxic reactions	alcohol, catecholamines, anthracyclines, radiation, misc.
Peripartal cardiomyopathy