Cardiomyopathy

OT Dude Academy’s Free NBCOT® Exam Prep Course Cardiology Cardiomyopathy

Cardiomyopathy

  • Associated with heart muscle or electrical dysfunction that often leads to progressive heart failure and mortality.
  • Involves thickened heart muscle or it is more rigid than normal.
  • Scar tissue may replace muscle tissue in rare cases.1 
  • Classified as primary or secondary.2 
    • Primary: genetic, mixed, or acquired
    • Secondary: infiltrative, toxic, or inflammatory
  • 4 Types: dilated, hypertrophic, restrictive, arrhythmogenic right ventricular3 4 5 6 7 8 9 10 
    • Dilated cardiomyopathy: enlarged ventricular chamber, normal/decreased wall thickness, systolic dysfunction
      • Symptoms: dyspnea, fatigue, cough, orthopnea, edema
      • Treatment: underlying cause, lifestyle changes, medications, cardiac resynchronization therapy, surgical revascularization, transplantation.
    • Hypertrophic cardiomyopathy: reduction in ventricular chamber volume
      • Symptoms: same as dilated cardiomyopathy
      • Treatment: symptom and complication reduction, drug therapy, heart transplantation
    • Restrictive cardiomyopathy: biatrial enlargement, normal/reduced ventricular volume, impaired ventricular filling
      • Symptoms: pulmonary congestion, dyspnea upon exertion, syncope
      • Treatment: chelation therapy, phlebotomy, bone marrow transplantation, salt restriction, implanted cardioverter-defibrillator
    • ARVC: Segmental wall abnormalities
      • Symptoms: syncope, atypical chest pain, tachycardia
      • Treatment: pharmacological treatment, catheter ablation, implanted cardioverter-defibrillator, transplantation
  • Causes of cardiomyopathy may be genetic, caused by CAD, hypertension, viral infection, valvular disease, genetic predisposition, neuromuscular diseases (Duchenne muscular dystrophy, Becker muscular dystrophy, Barth syndrome), or idiopathic.
  • Occupational therapy: structured exercise training program tailored to medical history, current physical activity, and heart failure symptomatology starting with 50-60% age-resting heart rate and gradually to 65-85% (13-15 Borg Scale) twice a week. Examples of equipment: treadmill, arm ergometer, upright cycle.11 
    • “The United States 36th Bethesda Conference guidelines find insufficient evidence to exclude these persons from competitive sports.”12 13 
    • “Patients with dilated cardiomyopathy experience pronounced restrictions in quality of life and psychological wellbeing”- addressing role limitations, social functioning, mental health (anxiety and depression), general health management, sleep, and vitality.14 
    • Making lifestyle changes: tobacco, alcohol, diet, sedentary lifestyle.15 16 17 18 19 20 

Clinical Code List of Cardiomyopathies

  • Ischaemic cardiomyopathy: Heart muscle weakness due to inadequate blood supply.
  • Cardiomyopathy: General term for diseases of the heart muscle.
  • Hypertrophic obstructive cardiomyopathy: Thickened heart muscle obstructs blood flow.
  • Obscure African cardiomyopathy: Rare heart disease primarily affecting individuals in Africa.
  • Other primary cardiomyopathies: Various primary heart muscle diseases not specified.
  • Congestive cardiomyopathy: Heart muscle disease causing heart failure.
  • Congestive obstructive cardiomyopathy: Combination of congestive heart failure and blood flow obstruction.
  • Constrictive cardiomyopathy: Heart muscle becomes rigid and restricts filling.
  • Familial cardiomyopathy: Genetic heart muscle disease running in families.
  • Hypertrophic non-obstructive cardiomyopathy: Thickened heart muscle without blood flow obstruction.
  • Primary dilated cardiomyopathy: Heart chamber enlargement and impaired contraction.
  • Takotsubo cardiomyopathy: Temporary heart muscle weakness triggered by stress.
  • Stress cardiomyopathy: Heart muscle weakness due to severe emotional or physical stress.
  • Other primary cardiomyopathy NOS: Unspecified primary heart muscle disease.
  • Nutritional and metabolic cardiomyopathies: Heart muscle diseases related to nutritional and metabolic issues.
  • Nutritional and metabolic cardiomyopathy NOS: Unspecified nutritional and metabolic heart muscle disease.
  • Cardiomyopathy in disease EC: Heart muscle disease associated with systemic conditions.
  • Cardiomyopathy in Friedreich’s ataxia: Heart muscle disease linked to Friedreich’s ataxia.
  • Cardiomyopathy in myotonic dystrophy: Heart muscle disease associated with myotonic dystrophy.
  • Dystrophic cardiomyopathy: Heart muscle disease related to muscle dystrophies.
  • Amyloid cardiomyopathy: Heart muscle disease due to amyloid protein deposits.
  • Cardiomyopathy in diseases EC, NOS: Unspecified heart muscle disease associated with systemic conditions.
  • Arrhythmogenic right ventricular cardiomyopathy: Heart muscle disease causing arrhythmias in the right ventricle.
  • Tachycardiomyopathy: Heart muscle disease due to prolonged high heart rate.
  • Tachycardia-induced cardiomyopathy: Heart muscle weakness caused by prolonged high heart rate.
  • Secondary cardiomyopathy NOS: Unspecified secondary heart muscle disease.
  • Secondary dilated cardiomyopathy: Heart chamber enlargement due to another condition.
  • Cardiomyopathy due to drugs and other external agents: Heart muscle disease caused by drugs or toxins.
  • Cardiomyopathy NOS: Unspecified heart muscle disease.
  • [X]Other hypertrophic cardiomyopathy: Other types of heart muscle thickening not specified.
  • [X]Other restrictive cardiomyopathy: Other types of rigid heart muscle diseases not specified.
  • [X]Other cardiomyopathies: Various unspecified heart muscle diseases.
  • [X]Cardiomyopathy in metabolic diseases CE: Heart muscle disease associated with metabolic conditions.
  • Cardiomyopathy in the puerperium: Heart muscle disease occurring after childbirth.21 

 

 

  1. Medline Plus. (n.d.). Cardiomyopathy. Retrieved from https://medlineplus.gov/cardiomyopathy.html[↩]
  2. Maron BJ, Towbin JA, Thiene G, et al. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation. 2006;113(14):1807–1816.[↩]
  3. Buja G, Estes NA, III, Wichter T, Corrado D, Marcus F, Thiene G. Arrhythmogenic right ventricular cardiomyopathy/dysplasia: risk stratification and therapy. Prog Cardiovasc Dis. 2008;50(4):282–293.[↩]
  4. Hulot JS, Jouven X, Empana JP, Frank R, Fontaine G. Natural history and risk stratification of arrhythmogenic right ventricular dysplasia/cardiomyopathy. Circulation. 2004;110(14):1879–1884.[↩]
  5. Rivenes SM, et al. Sudden death and cardiovascular collapse in children with restrictive cardiomyopathy. Circulation. 2000;102(8):876–882.[↩]
  6. Abraham WT, Hayes DL. Cardiac resynchronization therapy for heart failure. Circulation. 2003;108(21):2596–2603.[↩]
  7. Jones RH, Velazquez EJ, Michler RE, et al. the STICH Hypothesis 2 Investigators. Coronary bypass surgery with or without surgical ventricular reconstruction. N Engl J Med. In press http://content.nejm.org/ cgi/content/full/NEJMoa0900559. Published March 29, 2009. Accessed April 10, 2009.[↩]
  8. Rose EA, Gelijns AC, Moskowitz AJ, et al. the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) Study Group. Long-term mechanical left ventricular assistance for end-stage heart failure. N Engl J Med. 2001;345(20):1435–1443.[↩]
  9. Kushwaha SS, Fallon JT, Fuster V. Restrictive cardiomyopathy. N Engl J Med. 1997;336(4):267–276.[↩]
  10. Fenton MJ, et al. Heart and heart-lung transplantation for idiopathic restrictive cardiomyopathy in children. Heart. 2006;92(1):85–89.[↩]
  11. Klempfner, R., Kamerman, T., Schwammenthal, E., Nahshon, A., Hay, I., Goldenberg, I., … & Arad, M. (2015). Efficacy of exercise training in symptomatic patients with hypertrophic cardiomyopathy: results of a structured exercise training program in a cardiac rehabilitation center. European journal of preventive cardiology, 22(1), 13-19.[↩]
  12. Maron BJ, Ackerman MJ, Nishimura RA, Pyeritz RE, Towbin JA, Udelson JE. Task Force 4: HCM and other cardiomyopathies, mitral valve prolapse, myocarditis, and Marfan syndrome. J Am Coll Cardiol. 2005;45(8):1340–1345.[↩]
  13. Pelliccia A, Fagard R, Bjørnstad HH, et al.; Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology; Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Recommendations for competitive sports participation in athletes with cardiovascular disease: a consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J. 2005;26(14):1422–1445.[↩]
  14. Steptoe, A., Mohabir, A., Mahon, N. G., & McKenna, W. J. (2000). Health related quality of life and psychological wellbeing in patients with dilated cardiomyopathy. Heart, 83(6), 645-650.[↩]
  15. Fletcher, G. F., Balady, G., Blair, S. N., Blumenthal, J., Caspersen, C., Chaitman, B., … & Pollock, M. L. (1996). Statement on exercise: benefits and recommendations for physical activity programs for all Americans: a statement for health professionals by the Committee on Exercise and Cardiac Rehabilitation of the Council on Clinical Cardiology, American Heart Association. Circulation, 94(4), 857-862.[↩]
  16. Kokkinos, P., Myers, J., Kokkinos, J. P., Pittaras, A., Narayan, P., Manolis, A., … & Singh, S. (2008). Exercise capacity and mortality in black and white men. Circulation, 117(5), 614-622.[↩]
  17. Gulati, M., Black, H. R., Shaw, L. J., Arnsdorf, M. F., Merz, C. N. B., Lauer, M. S., … & Thisted, R. A. (2005). The prognostic value of a nomogram for exercise capacity in women. New England Journal of Medicine, 353(5), 468-475.[↩]
  18. Shiroma, E. J., & Lee, I. M. (2010). Physical activity and cardiovascular health: lessons learned from epidemiological studies across age, gender, and race/ethnicity. Circulation, 122(7), 743-752.[↩]
  19. Ezzati, M., Lopez, A. D., Rodgers, A., Vander Hoorn, S., Murray, C. J., & Comparative Risk Assessment Collaborating Group. (2002). Selected major risk factors and global and regional burden of disease. The Lancet, 360(9343), 1347-1360.[↩]
  20. Mozaffarian, D., Afshin, A., Benowitz, N. L., Bittner, V., Daniels, S. R., Franch, H. A., … & Zakai, N. A. (2012). Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American Heart Association. Circulation, 126(12), 1514-1563.[↩]
  21. Matthews, A., & Bhaskaran, K. (2017). Clinical code list-Cardiomyopathy.[↩]
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