Cardiomyology: an attempt to link structural cardiac and skeletal muscle damage in patients with dilated cardiomyopathy (original) (raw)
Related papers
Heart, 1996
Objective-In congestive heart failure (CHF) the skeletal muscle of the lower limbs develops a myopathy with atrophy and shift from the slow type to the fast type fibres. The aim was to test the hypothesis that this myopathy is specific and not simply related to detraining, by comparing patients with different degrees of CHF with patients with severe muscle atrophy due to disuse. Design-Case-control study involving 50-150 jg needle biopsies of the gastrocnemius muscle. By an electrophoretic micromethod, the three isoforms of myosin heavy chains (MHC) were separated. Patients-Five patients restricted to bed for more than one year because of stroke with disuse atrophy and normal ventricular function, and 19 with CHF were studied. There were seven age matched controls. Main outcome measures-The percentage of MHC1 (slow isoform), MHC2a (fast oxidative), and MHC2b (fast glycolytic) was determined by densitometric scan and correlated with indices of severity of cardiac failure. Results-Ejection fraction was 42-5 (SD 15.2)% in CHF, 59.5 (1.0)% in disuse atrophy and 60-3 (1.4)% in controls (P < 0 001 v both). The degree of muscle atrophy as calculated by the body mass index/gastrocnemius cross sectional area, showed a profound degree of atrophy in patients with muscle disuse [0.94 (0.39)]. This was worse than in the controls [4.27 (0.16), P < 0.0005] and the CHF patients [2.60 (1.10), P < 0.005]. Atrophy in CHF patients was also greater than in controls (P < 0.005). MHC1 was lower in CHF than in disuse atrophy [51.83 (15.04) v 84'5 (17.04), P < 0.01] while MHC2b was higher [23.5 (7.4) v 7'25 (7.92), P < 0.001]. There was a similar trend for MHC2a [24-83 (15.01) v 8 25 (9.12), P < 0.05]. Within the CHF group there was a positive correlation between NYHA class and MHC2a (r = 0-47, P < 0.05) and MHC2b (r = 0-55, P < 0.01) and a negative correlation between NYHA class and MHC1 (r =-0-74, P < 0.001). Similarly, significant correlations were found for ejection fraction, diuretic consumption score, exercise test tolerance, and degree of muscle atrophy. Conclusions-The CHF myopathy appears to be specific and not related to detraining. The magnitude of MCH redistribution correlates with the severity of the disease. The electrophoretic micromethod used is very sensitive and reproducible. Biopsies are so well tolerated that can be repeated frequently, allowing thorough follow up.
Muscle wasting in young patients with dilated cardiomyopathy
Journal of Cachexia, Sarcopenia and Muscle, 2017
Background Muscle wasting can be accelerated by chronic diseases such as heart failure and is one of the major causes of disability, morbidity, and mortality in this population. We aimed to investigate the incidence of muscle wasting and its associated factors in dilated cardiomyopathy patients younger than 55 years of age. Methods Between April 2014 and December 2015, all symptomatic patients with a diagnosis of non-ischaemic dilated cardiomyopathy who were referred to heart failure clinic were included in our study. Dual energy X-ray absorptiometry was used to evaluate body composition and identify muscle wasting. Muscle mass was calculated as the ratio of an individual's total lean mass of legs and arms (also called appendicular skeletal muscle) to their squared height (kg/m 2). The muscle mass values of less than 5.45 kg/m 2 for women and 7.26 kg/m 2 for men were considered low. Results A total of 55 patients (32 male) were included. The mean (standard deviation) of age was 37.3 (10.1) years, and the mean of left ventricular ejection fraction was 21.4%. Most of the patients were in the New York Heart Association classes of II and II-III. Twenty-six patients (47.3%) met criteria for muscle wasting. Patients with muscle wasting had lower left ventricular ejection fraction, lower 6-min walk distance, and higher New York Heart Association function class and hospitalization rate. Conclusions We concluded that muscle wasting might be present in younger patients with heart failure, particularly in those who are in worse clinical condition.
American family physician, 2009
Cardiomyopathy is an anatomic and pathologic diagnosis associated with muscle or electrical dysfunction of the heart. Cardiomyopathies represent a heterogeneous group of diseases that often lead to progressive heart failure with significant morbidity and mortality. Cardiomyopathies may be primary (i.e., genetic, mixed, or acquired) or secondary (e.g., infiltrative, toxic, inflammatory). Major types include dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy, and arrhythmogenic right ventricular cardiomyopathy. Although cardiomyopathy is asymptomatic in the early stages, symptoms are the same as those characteristically seen in any type of heart failure and may include shortness of breath, fatigue, cough, orthopnea, paroxysmal nocturnal dyspnea, and edema. Diagnostic studies include B-type natriuretic peptide levels, baseline serum chemistries, electrocardiography, and echocardiography. Treatment is targeted at relieving the symptoms of heart failure and r...
IOSR Journal of Dental and Medical Sciences, 2017
Cardiomyopathy is a primary disorder of the heart muscle that causes abnormal myocardial performance and is not the result of disease or dysfunction of other cardiac structures. Dilated cardiomyopathy is the most common variety of cardiomyopathy. Other types of cardiomyopathy are hypertrophic and restrictive cardiomyopathy. Dilated cardiomyopathy represents the final common pathway produced by a variety of ischaemic, toxic, metabolic and immunological mechanisms damaging the heart muscle. The incidence of DCM is reported to be 5 to 8 cases per 1,00,000 population per year. DCMP is more common in male and blacks. Natural history of DCM is not well established. The patient can present with variable symptoms like heart failure, arrhythmias, stroke or sudden death. Some may have minimal or no symptoms. The present study aims to evaluate the etiological, electrocardiographical, echocardiographical and clinical profile of DCMP patients. The present study is one year cross sectional study on patients admitted in the department of Medicine, RIMS Ranchi. Patient was included based on Clinical and Echocardiographic criteria while those with Valvular and Congenital heart disease were excluded. Statistical analysis was done with percentage, proportions, chi-square and correlation. The results of this study showed majority of patients were males compromising 56.6% and females were 43.25%. In males DCMP was mostly seen in elderly while in females it was mostly seen in middle age. The most common etiology was ischaemic DCMP comprising 33.3% patients, followed by diabetic, peripartum, idiopathic and alcoholic. The most common presentation in our study was biventricular failure which was seen in 80% of cases followed by isolated Left ventricular failure. Majority of patients were in NYHA class IV and III. Other symptoms were cough, easy fatiguability, pedal edema, abdominal pain, palpitation, chest pain and syncope. ECG findings included QRS axis deviation (left and right), ventricular ectopics, sinus tachycardia, LBBB, RBBB, AF, atrial ectopics, SVT, VT, CHB, LVH and nonspecific ST-T changes. Echocardiographic findings included reduced LV ejection fraction, MR, TR, LV clot and pericardial effusion. Chest radiography findings included increased cardiothoracic ratio, pleural effusion and pulmonary plethora. Conclusion of the study included most common type is DCMP, most common etiology is ischaemic and most common clinical presentation is biventricular failure. The most common ECG findings were sinus tachycardia and ventricular ectopics. In Echocardiography most common finding was reduced Left ventricular ejection fraction.
Primary muscle diseases in Thammasat University Hospital: muscle biopsy study of 12 cases
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2010
We reviewed retrospectively 12 muscle biopsies of patients who were clinically diagnosed with a primary muscle diseases from the clinical data base of Thammasat University Hospital from January 2005 to January 2007. Most patients were male and had median age of 30.5 years (range 14 to 56). The most common clinical presentation was proximal muscle weakness. Nine of eleven patients had elevated CK concentrations ranging from 338 to 1023 IU/L. Clinicopathological correlation revealed specific diagnoses in nine patients. Suspected cases of mitochondrial neurogastrointestinal encephalopathy (MNGIE), myofibrillar myopathy (MFM) and distal myopathy with rimmed vacuoles (DMRV) were confirmed by molecular genetic studies examining thymidine phosphorylase, GNE, ZASP myotilin, desmin, abeta-crystalline and filamin C genes. Specific histopathological findings on muscle biopsy help to select cases for advance molecular testing.
Medical conditions regarding heart failure
ACTA Medica Transilvanica
The increased incidence of cardiovascular diseases among adults causes interests in the study of pathologies of this functional system. In this context, it is envisaged that cardiovascular diseases, in addition to the clinical aspect, draw attention from a medical standpoint to the involvement of other organs belonging to other apparatus and systems. From this perspective, this study highlights the imagistic and structural aspects of cardiovascular disease and structural aspects of the disease prior to its installation, focusing on the organs involved with cardiovascular diseases. This study refers specifically to the conventional imagistic features that suggest heart failure and its evolution with possible decompensation. In order to extend this study, references to the normal structural aspects were made, regarding the organs and systems involved in the pathology of previously mentioned pathology, with their integrity before the onset of the disease.