Ischemic cardiomyopathy

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Ischemic Cardiomyopathy
Atherosclerosis diagram.png
Atherosclerosis one of the causes of this condition
Pronunciation
Specialty Cardiology
Symptoms Sudden fatigue
CausesAtherosclerosis, Vasospasm [1]
Diagnostic method MRI [2]
TreatmentPercutaneous intervention [3]

Ischemic cardiomyopathy is a type of cardiomyopathy caused by a narrowing of the coronary arteries which supply blood to the heart. [4] Typically, patients with ischemic cardiomyopathy have a history of acute myocardial infarction, [5] however, it may occur in patients with coronary artery disease, but without a past history of acute myocardial infarction. This cardiomyopathy is one of the leading causes of sudden cardiac death. [6] The adjective ischemic means characteristic of, or accompanied by, ischemia — local anemia due to mechanical obstruction of the blood supply. [7]

Contents

Signs and symptoms

Signs and symptoms of ischemic cardiomyopathy include sudden fatigue, shortness of breath, dizziness, and palpitations.[ citation needed ]

Cause

Ischemic cardiomyopathy is the cause of more than 60% of all cases of systolic congestive heart failure in most countries of the world. [6] [8] A chest radiograph that demonstrates coronary artery calcification is a probable indication of ischemic cardiomyopathy. [9] The following are causes of ischemic cardiomyopathy: [1]

Pathophysiology

Ischemic cardiomyopathy is caused by too little blood flow and hence oxygen reaching the muscular layer of the heart due to a narrowing of coronary arteries in turn causing cell death. This can cause different levels of tissue injury and affect large and intermediate arteries alike. [10] [11] [12]

Diagnosis

Ischemic cardiomyopathy can be diagnosed via magnetic resonance imaging (MRI) protocol, imaging both global and regional function. Also the Look-Locker technique is used to identify diffuse fibrosis; it is therefore important to be able to determine the extent of the ischemic scar. [2] Some argue that only left main- or proximal-left anterior descending artery disease is relevant to the diagnostic criteria for ischemic cardiomyopathy. [5] Myocardial imaging usually demonstrates left ventricular dilation, severe ventricular dysfunction, and multiple infarctions. [13] Signs include congestive heart failure, angina edema, weight gain and fainting, among others. [6] [14]

Management

Cardiac-Stem-Cells
Coronary bypass surgery Coronary artery bypass surgery Image 657C-PH.jpg
Coronary bypass surgery

Restoring adequate blood flow to the heart muscle in people with heart failure and significant coronary artery disease is strongly associated with improved survival, some research showing up to 75% survival rates over 5 years. [15] [16] A stem cell study indicated that using autologous cardiac stem cells as a regenerative approach for the human heart (after a heart attack) has great potential. [17]

American Heart Association practice guidelines recommend implantable cardioverter-defibrillator (ICD) use in those with ischemic cardiomyopathy (40 days post-MI) that are (NYHA) New York Heart Association functional class I. A LVEF measurement (simply called LVEF alone among cardiologists) of greater than (>) 30% is often used to differentiate primary from ischemic cardiomyopathy, and as a prognostic indicator. [18] [19]

A 2004 study showed the patients in that study who underwent ventricular restoration as well as a coronary artery bypass achieved greater postoperative LVEF than with the latter surgery alone. [20] Severe cases are treated with heart transplantation. [21]

Prognosis

One of the most important features differentiating ischemic cardiomyopathy from the other forms of cardiomyopathy is the shortened, or worsened all-cause mortality in patients with ischemic cardiomyopathy. According to several studies, coronary artery bypass graft surgery has a survival advantage over medical therapy (for ischemic cardiomyopathy) across varied follow-ups. [11] [22] [23] [24]

Related Research Articles

<span class="mw-page-title-main">Cardiology</span> Branch of medicine dealing with the heart

Cardiology is the study of the heart. Cardiology is a branch of medicine that deals with disorders of the heart and the cardiovascular system. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease, and electrophysiology. Physicians who specialize in this field of medicine are called cardiologists, a sub-specialty of internal medicine. Pediatric cardiologists are pediatricians who specialize in cardiology. Physicians who specialize in cardiac surgery are called cardiothoracic surgeons or cardiac surgeons, a specialty of general surgery.

<span class="mw-page-title-main">Coronary artery disease</span> Reduction of blood flow to the heart

Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), myocardial ischemia, or simply heart disease, involves the reduction of blood flow to the cardiac muscle due to build-up of atherosclerotic plaque in the arteries of the heart. It is the most common of the cardiovascular diseases. Types include stable angina, unstable angina, and myocardial infarction.

<span class="mw-page-title-main">Cardiomyopathy</span> Disease of the heart muscle

Cardiomyopathy is a group of primary diseases of the heart muscle. Early on there may be few or no symptoms. As the disease worsens, shortness of breath, feeling tired, and swelling of the legs may occur, due to the onset of heart failure. An irregular heart beat and fainting may occur. Those affected are at an increased risk of sudden cardiac death.

<span class="mw-page-title-main">Cardiac arrest</span> Sudden failure of heart beat

Cardiac arrest, also known as sudden cardiac arrest, is when the heart suddenly and unexpectedly stops beating. As a result, blood cannot properly circulate around the body and there is diminished blood flow to the brain and other organs. When the brain does not receive enough blood, this can cause a person to lose consciousness. Coma and persistent vegetative state may result from cardiac arrest. Cardiac arrest is also identified by a lack of central pulses and abnormal or absent breathing.

<span class="mw-page-title-main">Angina</span> Chest discomfort from heart muscles

Angina, also known as angina pectoris, is chest pain or pressure, usually caused by insufficient blood flow to the heart muscle (myocardium). It is most commonly a symptom of coronary artery disease.

An ejection fraction (EF) is the volumetric fraction of fluid ejected from a chamber with each contraction. It can refer to the cardiac atrium, ventricle, gall bladder, or leg veins, although if unspecified it usually refers to the left ventricle of the heart. EF is widely used as a measure of the pumping efficiency of the heart and is used to classify heart failure types. It is also used as an indicator of the severity of heart failure, although it has recognized limitations.

<span class="mw-page-title-main">Troponin</span> Protein complex

Troponin, or the troponin complex, is a complex of three regulatory proteins that are integral to muscle contraction in skeletal muscle and cardiac muscle, but not smooth muscle. Measurements of cardiac-specific troponins I and T are extensively used as diagnostic and prognostic indicators in the management of myocardial infarction and acute coronary syndrome. Blood troponin levels may be used as a diagnostic marker for stroke or other myocardial injury that is ongoing, although the sensitivity of this measurement is low.

<span class="mw-page-title-main">Left ventricular hypertrophy</span> Medical condition

Left ventricular hypertrophy (LVH) is thickening of the heart muscle of the left ventricle of the heart, that is, left-sided ventricular hypertrophy and resulting increased left ventricular mass.

<span class="mw-page-title-main">Percutaneous coronary intervention</span> Medical techniques used to manage coronary occlusion

Percutaneous coronary intervention (PCI) is a minimally invasive non-surgical procedure used to treat narrowing of the coronary arteries of the heart found in coronary artery disease. The procedure is used to place and deploy coronary stents, a permanent wire-meshed tube, to open narrowed coronary arteries. PCI is considered 'non-surgical' as it uses a small hole in a peripheral artery (leg/arm) to gain access to the arterial system, an equivalent surgical procedure would involve the opening of the chest wall to gain access to the heart area. The term 'coronary angioplasty with stent' is synonymous with PCI. The procedure visualises the blood vessels via fluoroscopic imaging and contrast dyes. PCI is performed by an interventional cardiologists in a catheterization laboratory setting.

Myocardial stunning or transient post-ischemic myocardial dysfunction is a state of mechanical cardiac dysfunction that can occur in a portion of myocardium without necrosis after a brief interruption in perfusion, despite the timely restoration of normal coronary blood flow. In this situation, even after ischemia has been relieved and myocardial blood flow (MBF) returns to normal, myocardial function is still depressed for a variable period of time, usually days to weeks. This reversible reduction of function of heart contraction after reperfusion is not accounted for by tissue damage or reduced blood flow, but rather, its thought to represent a perfusion-contraction "mismatch". Myocardial stunning was first described in laboratory canine experiments in the 1970s where LV wall abnormalities were observed following coronary artery occlusion and subsequent reperfusion.

<span class="mw-page-title-main">Takotsubo cardiomyopathy</span> Sudden temporary weakening of the heart muscle

Takotsubo cardiomyopathy or takotsubo syndrome (TTS), also known as stress cardiomyopathy, is a type of non-ischemic cardiomyopathy in which there is a sudden temporary weakening of the muscular portion of the heart. It usually appears after a significant stressor, either physical or emotional; when caused by the latter, the condition is sometimes called broken heart syndrome.

<span class="mw-page-title-main">Myocardial perfusion imaging</span> Nuclear medicine imaging method

Myocardial perfusion imaging or scanning is a nuclear medicine procedure that illustrates the function of the heart muscle (myocardium).

<span class="mw-page-title-main">Noncompaction cardiomyopathy</span> Congenital disease of heart muscle

Noncompaction cardiomyopathy (NCC) is a rare congenital disease of heart muscle that affects both children and adults. It results from abnormal prenatal development of heart muscle.

The following outline is provided as an overview of and topical guide to cardiology, the branch of medicine dealing with disorders of the human heart. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease and electrophysiology. Physicians who specialize in cardiology are called cardiologists.

<span class="mw-page-title-main">Coronary ischemia</span> Medical condition

Coronary ischemia, myocardial ischemia, or cardiac ischemia, is a medical term for abnormally reduced blood flow in the coronary circulation through the coronary arteries. Coronary ischemia is linked to heart disease, and heart attacks. Coronary arteries deliver oxygen-rich blood to the heart muscle. Reduced blood flow to the heart associated with coronary ischemia can result in inadequate oxygen supply to the heart muscle. When oxygen supply to the heart is unable to keep up with oxygen demand from the muscle, the result is the characteristic symptoms of coronary ischemia, the most common of which is chest pain. Chest pain due to coronary ischemia commonly radiates to the arm or neck. Certain individuals such as women, diabetics, and the elderly may present with more varied symptoms. If blood flow through the coronary arteries is stopped completely, cardiac muscle cells may die, known as a myocardial infarction, or heart attack.

<span class="mw-page-title-main">Myocardial infarction</span> Interruption of cardiac blood supply

A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops in one of the coronary arteries of the heart, causing infarction to the heart muscle. The most common symptom is retrosternal chest pain or discomfort that classically radiates to the left shoulder, arm, or jaw. The pain may occasionally feel like heartburn.

<span class="mw-page-title-main">Anomalous left coronary artery from the pulmonary artery</span> Medical condition

Anomalous left coronary artery from the pulmonary artery is a rare congenital anomaly occurring in approximately 1 in 300,000 liveborn children. The diagnosis comprises between 0.24 and 0.46% of all cases of congenital heart disease. The anomalous left coronary artery (LCA) usually arises from the pulmonary artery instead of the aortic sinus. In fetal life, the high pressure in the pulmonic artery and the fetal shunts enable oxygen-rich blood to flow in the LCA. By the time of birth, the pressure will decrease in the pulmonic artery and the child will have a postnatal circulation. The myocardium, which is supplied by the LCA, will therefore be dependent on collateral blood flow from the other coronary arteries, mainly the RCA. Because the pressure in RCA exceeds the pressure in LCA a collateral circulation will increase. This situation ultimately can lead to blood flowing from the RCA into the LCA retrograde and into the pulmonary artery, thus forming a left-to-right shunt.

<span class="mw-page-title-main">Reperfusion therapy</span> Restoring blood flow post-heart attack

Reperfusion therapy is a medical treatment to restore blood flow, either through or around, blocked arteries, typically after a heart attack. Reperfusion therapy includes drugs and surgery. The drugs are thrombolytics and fibrinolytics used in a process called thrombolysis. Surgeries performed may be minimally-invasive endovascular procedures such as a percutaneous coronary intervention (PCI), which involves coronary angioplasty. The angioplasty uses the insertion of a balloon and/or stents to open up the artery. Other surgeries performed are the more invasive bypass surgeries that graft arteries around blockages.

Remote ischemic conditioning (RIC) is an experimental medical procedure that aims to reduce the severity of ischaemic injury to an organ such as the heart or the brain, most commonly in the situation of a heart attack or a stroke, or during procedures such as heart surgery when the heart may temporary suffer ischaemia during the operation, by triggering the body's natural protection against tissue injury. Although noted to have some benefits in experimental models in animals, this is still an experimental procedure in humans and initial evidence from small studies have not been replicated in larger clinical trials. Successive clinical trials have failed to identify evidence supporting a protective role in humans.

<span class="mw-page-title-main">Roberto Ferrari (cardiologist)</span> Italian Cardiologist

Roberto Ferrari is an Italian cardiologist who holds the position of Emeritus Professor at the University of Ferrara, where besides he was the chair of the Cardiology in the School of Medicine until the 2019–2020 academic year.

References

  1. 1 2 Bisognano, John D.; Baker, Marc L.; Earley, Mary Beth (2009-04-09). Manual of Heart Failure Management. Springer Science & Business Media. p. 50. ISBN   9781848821859.
  2. 1 2 Hodler, Jurg (2015). Diseases of the Chest and Heart: Diagnostic Imaging and Interventional. Springer. p. 146. ISBN   978-88-470-5751-7 . Retrieved 10 September 2015.
  3. ↑ Burke, Allen P.; Tavora, Fabio (2010). Practical Cardiovascular Pathology. Lippincott Williams & Wilkins. p. 96. ISBN   9781605478418 . Retrieved 2 January 2018.
  4. ↑ "Cardiomyopathy: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2015-09-09.
  5. 1 2 Felker, G.Michael; Shaw, Linda K; O’Connor, Christopher M (January 2002). "A standardized definition of ischemic cardiomyopathy for use in clinical research". Journal of the American College of Cardiology. 39 (2): 210–218. doi: 10.1016/S0735-1097(01)01738-7 . PMID   11788209.
  6. 1 2 3 Reynolds Delgado (21 April 2009). Interventional Treatment of Advanced Ischemic Heart Disease. Springer Science & Business Media. pp. 39–. ISBN   978-1-84800-395-8.
  7. ↑ "Silent Ischemia and Ischemic Heart Disease".
  8. ↑ Griffin, Brian P. (2012-10-01). Manual of Cardiovascular Medicine. Lippincott Williams & Wilkins. p. 130. ISBN   9781451131604.
  9. ↑ Brant, William E.; Helms, Clyde A. (2007-01-01). Fundamentals of Diagnostic Radiology. Lippincott Williams & Wilkins. p. 635. ISBN   9780781761352.
  10. ↑ Anversa, Piero; Sonnenblick, Edmund H. (1990). "Ischemic cardiomyopathy: Pathophysiologic mechanisms". Progress in Cardiovascular Diseases. 33 (1): 49–70. doi:10.1016/0033-0620(90)90039-5. ISSN   0033-0620. PMID   2142312.
  11. 1 2 Yatteau, Ronald F.; Peter, Robert H.; Behar, Victor S.; Bartel, Alan G.; Rosati, Robert A.; Kong, Yihong (1974). "Ischemic cardiomyopathy: The myopathy of coronary artery disease". The American Journal of Cardiology. 34 (5): 520–525. doi:10.1016/0002-9149(74)90121-0. ISSN   0002-9149. PMID   4278154.
  12. ↑ Mann DL, Zipes DP, Libby P, Bonow RO (30 July 2014). Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. Elsevier Health Sciences. pp. 1225–. ISBN   978-0-323-29064-7.
  13. ↑ E. van der Wall; K.J. Lie (6 December 2012). Recent Views on Hypertrophic Cardiomyopathy. Springer Science & Business Media. pp. 43–. ISBN   978-94-009-4994-2.
  14. ↑ Allen P. Burke; Fabio Tavora (8 November 2010). Practical Cardiovascular Pathology. Lippincott Williams & Wilkins. pp. 96–. ISBN   978-1-60547-841-8.
  15. ↑ Luciani, Giovanni Battista; Montalbano, Giuseppe; Casali, Gianluca; Mazzucco, Alessandro (2000). "Predicting long-term functional results after myocardial revascularization in ischemic cardiomyopathy". The Journal of Thoracic and Cardiovascular Surgery. 120 (3): 478–489. doi: 10.1067/mtc.2000.108692 . ISSN   0022-5223. PMID   10962408.
  16. ↑ Falk, Erling; Shah, Prediman; Feyter, Pim de (2007-03-28). Ischemic Heart Disease. CRC Press. p. 226. ISBN   9781840765151.
  17. ↑ Cai, Lu; Keller, Bradley B (2014-01-03). "Cardiac regeneration and diabetes". Regenerative Medicine Research. 2 (1): 1. doi: 10.1186/2050-490X-2-1 . ISSN   2050-490X. PMC   4422323 . PMID   25984329.
  18. ↑ Iskandrian, Abdulmassih S.; Helfeld, Hope; Lemlek, Joseph; Lee, Jaetae; Iskandrian, Basil; Heo, Jaekyeong (1992). "Differentiation between primary dilated cardiomyopathy and ischemic cardiomyopathy based on right ventricular performance". American Heart Journal. 123 (3): 768–773. doi:10.1016/0002-8703(92)90518-Z. ISSN   0002-8703. PMID   1539529.
  19. ↑ Hunt, S. A. (20 September 2005). "ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult--Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): Developed in Collaboration With the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: Endorsed by the Heart Rhythm Society". Circulation. 112 (12): 1825–1852. doi: 10.1161/CIRCULATIONAHA.105.167587 .
  20. ↑ Maxey, Thomas S; Reece, T.Brett; Ellman, Peter I; Butler, Paris D; Kern, John A; Tribble, Curtis G; Kron, Irving L (2004). "Coronary artery bypass with ventricular restoration is superior to coronary artery bypass alone in people with ischemic cardiomyopathy". The Journal of Thoracic and Cardiovascular Surgery. 127 (2): 428–434. doi: 10.1016/j.jtcvs.2003.09.024 . ISSN   0022-5223. PMID   14762351.
  21. ↑ Louie HW, Laks H, Milgalter E, Drinkwater DC, Hamilton MA, Brunken RC, Stevenson LW (November 1991). "Ischemic cardiomyopathy. Criteria for coronary revascularization and cardiac transplantation". Circulation . 84 (5 Suppl): III290–III295. PMID   1934422.
  22. ↑ O’Connor, Christopher M; Velazquez, Eric J; Gardner, Laura H; Smith, Peter K; Newman, Mark F; Landolfo, Kevin P; Lee, Kerry L; Califf, Robert M; Jones, Robert H (2002). "Comparison of coronary artery bypass grafting versus medical therapy on long-term outcome in patients with ischemic cardiomyopathy (a 25-year experience from the Duke Cardiovascular Disease Databank)". The American Journal of Cardiology. 90 (2): 101–107. doi:10.1016/S0002-9149(02)02429-3. ISSN   0002-9149. PMID   12106836.
  23. ↑ Velazquez, Eric J.; Williams, Judson B.; Yow, Eric; Shaw, Linda K.; Lee, Kerry L.; Phillips, Harry R.; O’Connor, Christopher M.; K.Smith, Peter; Jones, Robert H. (2012-02-01). "Long-term Survival of Patients with Ischemic Cardiomyopathy Treated by CABG versus Medical Therapy". The Annals of Thoracic Surgery. 93 (2): 523–530. doi:10.1016/j.athoracsur.2011.10.064. ISSN   0003-4975. PMC   3638256 . PMID   22269720.
  24. ↑ Elefteriades, John A; Morales, David L.S; Gradel, Christophe; Tollis, George; Levi, Evelyn; Zaret, Barry L (1997). "Results of Coronary Artery Bypass Grafting by a Single Surgeon Patients With Left Ventricular Ejection Fractions ≤30%". The American Journal of Cardiology. 79 (12): 1573–1578. doi: 10.1016/S0002-9149(97)00201-4 . ISSN   0002-9149. PMID   9202343.

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