Cardiomyopathies - Causes & Symptoms - Cardiology

today we will be discussing our about cardiomyopathies cardiomyopathies our special group of myocardial dysfunction right in with this defect primarily within the myocardium right now to make that concept clear about cardiomyopathy right or the disease of the myocardium you have to remember that there are certain conditions which should be saluted right for example myocardial damage due to high blood pressure hypertension myocardial damage due to is coronary artery disease or myocardial damage which is due to valvular heart disease valvular heart disease and congenital heart disease and then we can talk about inflammation these five conditions are not included in cardiomyopathies when there are myocardial damages related with hypertension a myocardial damage related with coronary artery disease or myocardial damage secondary to welder all disease or myocardial damage related with the congenital conditions or myocardium is inflamed when actively inflamed all these conditions are not included in cardiomyopathies right it means that cardiomyopathy is due to some intrinsic defect in myocardium or some disease which lead to primary abnormality within the myocardium which is not due to hypertension again what is cardiomyopathy cardiomyopathy is pathological conditions of myocardium which are not due to hypertension not due to coronary artery disease is not due to well or heart disease is not due to congenital heart diseases and in which myocardium is not actively inflamed right primarily cardiomyopathy they are divided into three groups primarily cardiomyopathies are divided into three groups and these are dilating dilated cardiomyopathy cardiomyopathy hypertrophic hyper trophic cardiomyopathy and there is restrictive cardio myopathy restrictive restrictive cardiomyopathy this dilated maybe there's a hypertrophic cardiomyopathy and there is restrictive cardiomyopathy a simple diagram let's see how they are different from each other in dilated cardiomyopathy what really happens that left ventricle is pathologically dilated or even right ventricle is also pathologically dilated right dilated cardiomyopathy which is also called congestive cardiomyopathy then little cardiomyopathy is also called unjust if cardiomyopathy in this case what really happens that myocardium become ballooned out its pathologically dilated and this pathologically dilated myocardium cannot contract well it cannot contract well there is global hypokinesia of the myocardium this is global impairment in the movement of myocardium hypokinesia mean movement of myocardium this global impairment in the contractility of myocardium if you want to remember a single sentence there is global impairment in the contractility of myocardium usually left ventricle as well as right one zero is the right it is slowly contracting poorly contracting hard or we can say it's hypokinetic heart it is large but hypo kinetic heart and of course it's a failing heart and this this failure will be - slowly failure or systolic failure it is it is not diastolic failure because during the - Slee it can accommodate the incoming blood but during the systole it cannot contract well so this is basically a systolic failure dilating cardiomyopathy which is right ventricular and left ventricular both both ventricles become ballooned out they like a balloon they enlarge they become very poorly contractile chambers and we say that de-rating cardiomyopathy the condition in which this biventricular failure with pathologically dilated both chamber and remember this global impairment in contraction because if there is only segmental impairment in contraction that maybe is chemic heart disease but in cardio myopathy gelatine cardiomyopathy there is global problem throughout the myocardium does that right so this is clinically coming as systolic failure its systolic failure failure of contraction the real problem is systolic failure and patient will develop right now opposite to that hypertrophic cardiomyopathy is different hypertrophic cardiomyopathy is different in this case this pathological hypertrophy of myocardium let me explain that let's suppose this is the normal left ventricular chamber suppose this is the normal nephron tubular chamber and here is your aortic valve here is your your design now when it undergoes hypertrophic cardiomyopathy it develops pathological hypertrophy and specially the siper trophy is very pronounced in septum other part of myocardium is only mildly hypertrophic but septum interventricular septum is grossly hypertrophied very severely hypertrophic and specially in this case which part of the myocardium is hypertrophic both septum which part of the septum upper part of the septum right now this septal hypertrophy right it has a very special type of hemodynamic problem look here ventricle will contact strongly because there is more muscle it will contract strongly it is hyperkinetic hard it is hyper kinetic heart remember dilated cardiomyopathy will hypokinetic this is hyper connected but there is one problem look here please attention here you know whenever ventricle contract septum becomes shorter septum becomes shorter and then septum becomes shorter this obstruction bulges in the cavity this obstruction will belgin during every systole this obstruction specially in 30 40 % of these patient this obstruction dynamically during the systole or contraction bulges into cavity and when it will bulge further into cavity it will produce an obstruction to outflow it will produce an obstruction to the outflow right so it is not normal hypertrophy you know i Petroff is seen in hybrid hypertension disease hypertrophy seen in your text in OSes that hypertrophy is usually symmetrical hypertrophy symmetrical mean that hypertrophy is equal in all parts for example if I'm having hypertension right let's suppose someone has hypertension or your aortic stenosis then hypertrophy will be equal and symmetrical in all part of myocardium so this type of hypertrophy is called symmetrical hypertrophy we are cavity remain oval or ovoid but in this particular condition the hypertrophy is asymmetrical so some people call it hypertrophic cardiomyopathy as asymmetric cardiomyopathy the college asymmetric hypertrophic cardiomyopathy is neutral this point is very important because septum is too much hypertrophic as compared to the remaining myocardium and during contraction when septum shrinks right then this obstruction become more pronounced because when it will shrink in this way it will bulge as a big obstruction to the outflow because it produces outflow obstruction this is very commonly called hypertrophic obstructive cardiomyopathy and the name is that there is hypertrophy which is leading to obstruction hypertrophic of have cardiomyopathy or simply call it obstructive hypertrophic cardiomyopathy is that right now and you confuse these two conditions is a very different this is poorly contacting heart it is vigorously contracting strongly contacting heart here on echocardiogram you find a very big heart with a very big cavity is the right and Julie thin-walled myocardium and myocardial contractility is poor throughout all elements of the wall but when you check this hypertrophic cardiomyopathy on the echocardiography number one you find this hypertrophy and number two is more important than number one that hypertrophy is asymmetrical especially septal hypertrophy is more pronounced than the free wall hypertrophy of the ventricle currently cavity of the cavity of the ventricle is abnormal it's something like banana ship now look at this cavity it's something like banana shaped cavity so this is abnormal you can say that cavity of this is right this is banana shaped cavity right right now this is balloon like this is banana ship is that right now these two I hope you will not confuse now we come to the third type of hypertrophy and in third type of hypertrophy first you look at the ventricle a third type of cardiomyopathy and third type of cardiomyopathy what's wrong that there are pathological infiltrations they are pathological infiltration Zinda what is this myocardium and due to this pathological infiltrations myocardium become firm and the real problem is failure to relaxation a real problem is I should write it here case the real problem is failure to relaxation failure to relaxation right that during this is look at it due to infiltration this become thickened you too thick myocardium right and this myocardium which is thick right it feel to relax properly it feel to relax properly and because it does not relax properly do you think during diastole it will fill properly no so it will lead to a problem during the - lay that function of the myocardium is that during systole should contract well and during - Lee should relax normal function of myocardium is during the isolation relax so that incoming blood can be accommodated so that it can be pumped in the next feed but the problem is this here the left ventricle our ventricular wall is infiltrated with some for example like amyloid material abnormal protein or infiltrated with sarcoid granulomas or infiltrated by you can say what is this hemochromatosis immigrant offices iron overloading conditions so if there is some pathological infiltrations and myocardial wall become thick and firm and it failed to relax during - lee it will lead to diastolic failure it will lead to what type of failure diastolic failure soon echocardiography because one of the best way to diagnosis echocardiography in echocardiography in dilated cardiomyopathy is you find that ventricles are ballooned out and thinned out right and they are very poorly contractile and leading to systolic dysfunction or systolic failure this is the right hypokinetic heart when we talk about hypertrophic obstructive cardiomyopathy this is the second group of the problem what's wrong with the second group that is pathological asymmetric hypertrophy of the myocardial ventricular walls and the maximum hypertrophy is seen in the interventricular septum especially in its upper part right and the main problem here is not contractility main problem is abnormal dynamics of contraction due to outflow obstruction is right the real problem is not the contraction right from curtain it is okay but curtain contractility becomes abnormal due to abnormal cavity and due to an element of dynamic obstruction you know if there's a or ticks tneows is obstruction that is called fixed obstruction but when this septum you know it bulges into cavity and when it during systole when it bulges in the cavity even mitral valve also hit here so both of them together they act as outflow obstruction that is why this asymmetrical hypertrophy which is leading to outflow obstruction nephron tubular cavity outflow obstruction is also called hypertrophic obstructive cardiomyopathy okay there's only one Center if you want to remember only one sentence about this condition if you want to remember only one sentence let me turn this type of cardiomyopathy is 50% cases are 50% cases are familiar familial but 100% cases of genetic mutation 100% almost hundred-percent patient have genetic defect I will explain it later out of this 50% cases are familial and 50% cases are sporadic for example if you have 100 patient with the hypertrophic obstructive cardiomyopathy and 50% patient you will find a family history of such problems and 50% of them you will not have the family history it means there is also mutation here there's also mutation here but this mutation is a new mutation this is a new mutation and this is a mutation which is inherited generation after generation it is autosomal dominant autosomal dominant mean that out of two alleles even if one gene is defective disease will be there this is the right out of you know one gene come from weather and other set of gene come from father even if one set of gene is defective disease will be there right so what we is really see here that it is 50 percent almost 100 percent cases they have mutations out of them 50 percent have inherited mutations 50 percent of sporadic cases but yet the most important sentence is not there the most important sentence related with this is that the most important concept related with this is there this is a cause of unexplained death in the jungle it's especially in the boys yeah yeah in some family may be you mother tell the young boy please don't play too much don't play do the aggressive athletic activity your father died in the ground suddenly right but why you know boys don't listen when they are a dollar sign he may go into vigorous activity right and he may suddenly one day collapse on the ground and die at the spot and later on autopsy you will find that there is hypertrophic obstructive cardiomyopathy this is the more common cause of sudden cardiac death in young athletes during the vigorous and physical activity right there's the most important cause what is the reason that isn't being when they're doing a lot of physical activity is their right heart become more dynamic and if heart is becoming more dynamic obstruction become more pronounced and when obstructions become more pronounced it becomes more difficult to eject is a right and doing the physical activity not only of obstruction is more pronounced it means you know outflow will be less an erotic feeling will be less pressure in irritable drop very severe exercise is obstruction right obstruction which is increased in dynamic City as heart rate goes up your aura is overfilled or under failed under fail at the top when his real physical activity most of the arterioles will relax so whatever blood is here it will be stolen away by the peripheral system so very little blood is left to perfuse coronary artery so when they do lot of physical activity the cardiac output drops because during severe physical activities and sympathetic nervous system is more active heart rate goes up obstruction become more dynamic outflow become less at the top during physical activity most of the muscles blood vessels relaxed arterioles relax so blood will wash away to less resistant areas so there will be more blood flow to the muscles pressure in the root of a rota is less very little blood go into the myocardium this may precipitate severe ischemia and conduction abnormalities and fatal cardiac arrhythmias so what really happens to this patient that patient may undergo fatal cardiac ventricular of course arrhythmias and - may be there at the spot so hope first and second case you will not confuse right in third case it's entirely different problem is that ventricle failed to relax regular wall the thick hair size is almost normal but ventricle is thick failed to relax during - clay failed to accommodate enough preload failed to accommodate an offender's frolic volume right and that will lead to back pressure is that right let us have a break and then we'll continue you

Channel: Dr. Najeeb Lectures

Views: 222,688

Keywords: Cardiomyopathies, dr najeeb, dr najeeb lectures, medical lectures, medical education, cardiac, pathology, heart, hypertrophic cardiomyopathy, armando hasudungan, usmle step 1, medical school, clinical medicine, medical videos, usmle, medicine, physiology, cardiology, lecturio, internal medicine, pathoma, medschool, usmle step 1 videos, anatomy, medical student, Cardiomyopathy (Disease Or Medical Condition), Health (Industry), usmle step 2, med school, medical, medical course

Id: EeYrMLMUpBQ

Length: 20min 44sec (1244 seconds)

Published: Thu Feb 21 2019