Cardiology

Cardiomyopathy: classification and causes of development

Written by med

Cardiomyopathy (according to the world Health Organization) is a group of cardiac diseases, accompanied by damage to the heart muscle (myocardium). The onset and progression of pathology can occur independently or in the background of diseases associated with the cardiovascular system.

The content of the article

  • Classification of cardiomyopathy
  • The causes of primary cardiomyopathy
  • Treatment of primary cardiomyopathy
  • Diseases leading to secondary cardiomyopathy

Since 1995, the term “cardiomyopathy” have become absolutely all diseases, accompanied by the defeat of the muscular layer of the heart. Thus, the occurrence of myocardial pathology, including diseases such as damage to the valve, hypertension (chronically high blood pressure) and CHD (coronary heart disease) has become quite high.

However, it is advisable cardiomyopathy not be considered the sum of all separate diseases of the heart and myocardial changes resulting from any violation of the body or of certain organs and systems.

Classification of cardiomyopathy

All cardiomyopathies can be divided into several groups depending on the mechanism of development and the causes of the disease. As mentioned above, this pathology may develop either in the background of any disease, or for no apparent reason. In the second case, often the “culprit” of the disease diagnose at all is not possible.

Depending on the causes of the disease cardiomyopathies are divided into:

  • primary (where the cause is not fully installed);
  • secondary (disease of the myocardium installed).

Depending on the mechanism of the disease development of cardiomyopathy are divided into:

  • dilated;
  • hypertrophic;
  • alcohol;
  • dishormonal;
  • restrictive.

 

The types of primary cardiomyopathies the development of primary cardiomyopathy primary cardiomyopathy can cause some genetic changes, viral infection, autoimmune disorders and idiopathic myocardial fibrosis.

Often a genetic factorwhich has caused development of the disease, cannot detect. This is because in all the metabolic processes occurring in cardiomyocytes (muscle cells of the heart), involves a large number of proteins. The violation of one or more of them may cause this pathology.

Multiple studies confirm viral nature of the occurrence of myopathies of the heart. The proof theory is found in the cardiomyocytes of antibodies (immune cells produced in response to the penetration of alien substances (the virus) in the body) to some viruses. Currently, it is known that cytomegalovirus, hepatitis C virus and Coxsackie virus can disrupt the DNA chain and, thereby, to cause cardiomyopathy.

There is a strong theory that some autoimmune disorders can cause cardiomyopathy. The essence of this mechanism of disease development lies in the fact that their own the human immune system detects the cells of the myocardium as “alien”. As a result in the body to their heart cells produces antibodies that damage the myocardium. The reason for this behavior can be immune to some bacteria, viruses, or other pathological processes.

Very often develops cardiomyopathy due to idiopathic fibrosis of the myocardium, in other words – cardiosclerosis. In this case, heart muscle cells are gradually replaced by connective tissue. The result is reduced elasticity of the fibers cease to contract and there is a disruption of the entire organ. It also may occur after inflammatory heart disease (myocarditis) or myocardial infarction. In this case we talk about secondary cardiomyopathy.

Treatment of primary cardiomyopathy

Due to the fact that the cause of primary cardiomyopathy cannot be established, the main treatment here is aimed at addressing the symptoms. In this case, all therapy is aimed at compensation for heart failure, occurred on the background of lesions of the myocardium.

 

Refinement and weakening of the vessel walls is one of the manifestations of cardiomiopatiei, leading to secondary cardiomyopathy

The main reasons for the development of secondary cardiomyopathy are independent of the disease. The main ones:

  • coronary heart disease (CHD);
  • hypertension (high blood pressure);
  • endocrine pathology;
  • infectious lesions of the heart muscle;
  • disease the accumulation of substances;
  • some diseases of connective tissue;
  • electrolyte imbalance in the body;
  • neuromuscular pathology;
  • amyloidosis;
  • some poisoning;
  • cardiomyopathy pregnant.

Ischemic disease of the heart implies some conditions in which the myocardium is not enough enriched blood and, consequently, oxygen. The main reason for the narrowing of the coronary arteries (blood vessels feeding the heart) due to atherosclerosis. Oxygen deficiency leads to a progressive destruction of cardiomyocytes. Subsequently, the muscle cells are replaced by connective tissue.

Hypertension (high blood pressure) during the long-term also leads to disruption of the myocardial structure. This is due to the fact that the heart harder to pump blood throughout the body in conditions of initially high pressure in the blood vessels. Eventually, the heart muscle loses its elasticity, leading to cardiomyopathy.

Often the cause of malfunctions of the myocardium is endocrine pathology (hormonal disorders). The primary mechanism of damage to the heart muscle is associated with excessive stimulation of its work certain hormones. The main endocrine diseases that may be complicated by the development of cardiomyopathy are:

  • diabetes mellitus;
  • diseases of the adrenal glands;
  • the malfunction of the thyroid gland.

Virtually all infectious lesions of the myocardium are accompanied by its inflammation — myocarditis. In this case, the microorganisms in the thickness of the muscle cause swelling and cell death. In their place there is connective tissue, which does not allow the heart to operate normally. Eventually developing a cardiomyopathy.

In addition to connective tissue, the disruption of the heart can cause foreign substances, which are deposited and accumulate in the myocardium. This happens when the disease of accumulation:

  • Refsum syndrome – a genetic disorder, accompanied by the accumulation of phytanic acid;
  • the disease paints – genetically due to the accumulation of sphingolipids;
  • disease accumulation of glycogen;
  • hemochromatosis – iron deposition in body tissues.

The following group of diseases leading to the development of cardiomyopathy, is a systemic failure of the connective tissue of man. Despite the fact that the basic structure of the myocardium are cardiomyocytes, the heart muscle is normally present also elements of connective tissue. Its cells can become inflamed and lead to infarction, in which normal cells are replaced by connective tissue. This is the main cause of cardiomyopathy.

Systemic connective tissue disease complicated by cardiomyopathy:

  • rheumatoid arthritis;
  • systemic sclerosis;
  • dermatomyositis;
  • systemic lupus erythematosus.

Electrolyte imbalance – increase or decrease level of ions in the blood (potassium, calcium, chlorine, phosphorus, magnesium) can also lead to the development of cardiomyopathy due to the disruption of the heart and changes in the structure of the myocardium. This occurs with prolonged diarrhea, or in some diseases of the kidneys.

Under neuromuscular diseases refers to certain disorders of the nervous fibre, which prevent normal transmission of impulse to the myocardium. Because of this, the heart muscle is reduced correctly (irregularly or with insufficient force). Sometimes disorders cause the heart walls can’t even hold a tone. All of the above is the cause of cardiomyopathy.

 

Stretching of the cavities of the heart during cardiomyopathy can affect the lungs and liver

Following pathology, in which disrupted the function of the heart muscle, is a separate disease – amyloidosis. It is the accumulation of amyloid (a protein-polysaccharide complex) in the myocardium, which leads to disruption of its decline and progression of heart failure.

In nature, there are a number of toxins (poisons) in a relatively short period of time can disrupt normal heart activity. In cases of poisoning with such substances is a violation of nervous impulse system of the heart or direct injury of cardiomyocytes. To such poisons in the first place include:

  • alcohol;
  • heavy metals (mercury, arsenic, lead, etc.);
  • drugs and substances (amphetamines).

The same violation of the myocardium also leads to radiation exposure in high doses. Usually the above-described reversible cardiomyopathy, however, in the case of chronic effects of these substances on the body (for example, the systematic use of alcoholic drinks), the disease cure is not possible.

Reversible cardiomyopathy may develop during pregnancy. This happens either in recent months or immediately after birth. This is because in women there is a change in hemodynamics (blood circulation) in connection with the need to supply the fetus. In such cases there is a change in blood volume and blood pressure.

Thus, we can conclude that the treatment of cardiomyopathy depends on the reasons that caused it. And only if the “culprit” of the disease is not found, to speak a primary pathology of the myocardium.

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