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 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 muscle due to plaque buildup in the hearts arteries

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 heart 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. A common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw. Occasionally it may feel like heartburn. Usually symptoms occur with exercise or emotional stress, last less than a few minutes, and improve with rest. Shortness of breath may also occur and sometimes no symptoms are present. In many cases, the first sign is a heart attack. Other complications include heart failure or an abnormal heartbeat.

<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">Angina</span> Chest discomfort due to not enough blood flow to heart muscle

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.

<span class="mw-page-title-main">Coronary artery bypass surgery</span> Surgical procedure to restore normal blood flow to an obstructed coronary artery

Coronary artery bypass surgery, also known as coronary artery bypass graft, is a surgical procedure to treat coronary artery disease (CAD), the buildup of plaques in the arteries of the heart. It can relieve chest pain caused by CAD, slow the progression of CAD, and increase life expectancy. It aims to bypass narrowings in heart arteries by using arteries or veins harvested from other parts of the body, thus restoring adequate blood supply to the previously ischemic heart.

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">Hypertensive heart disease</span> Medical condition

Hypertensive heart disease includes a number of complications of high blood pressure that affect the heart. While there are several definitions of hypertensive heart disease in the medical literature, the term is most widely used in the context of the International Classification of Diseases (ICD) coding categories. The definition includes heart failure and other cardiac complications of hypertension when a causal relationship between the heart disease and hypertension is stated or implied on the death certificate. In 2013 hypertensive heart disease resulted in 1.07 million deaths as compared with 630,000 deaths in 1990.

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

Percutaneous coronary intervention (PCI) is a non-surgical procedure used to treat narrowing of the coronary arteries of the heart found in coronary artery disease. The process involves combining coronary angioplasty with stenting, which is the insertion of a permanent wire-meshed tube that is either drug eluting (DES) or composed of bare metal (BMS). The stent delivery balloon from the angioplasty catheter is inflated with media to force contact between the struts of the stent and the vessel wall, thus widening the blood vessel diameter. After accessing the blood stream through the femoral or radial artery, the procedure uses coronary catheterization to visualise the blood vessels on X-ray imaging. After this, an interventional cardiologist can perform a coronary angioplasty, using a balloon catheter in which a deflated balloon is advanced into the obstructed artery and inflated to relieve the narrowing; certain devices such as stents can be deployed to keep the blood vessel open.

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. Examples of physical stressors that can cause TTS are sepsis, shock, subarachnoid hemorrhage, and pheochromocytoma. Emotional stressors include bereavement, divorce, or the loss of a job. Reviews suggest that of patients diagnosed with the condition, about 70–80% recently experienced a major stressor, including 41–50% with a physical stressor and 26–30% with an emotional stressor. TTS can also appear in patients who have not experienced major stressors.

<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 a 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 blood supply to a part of the heart

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 chest pain or discomfort which may travel into the shoulder, arm, back, neck or jaw. Often it occurs in the center or left side of the chest and lasts for more than a few minutes. The discomfort may occasionally feel like heartburn. Other symptoms may include shortness of breath, nausea, feeling faint, a cold sweat, feeling tired, and decreased level of consciousness. About 30% of people have atypical symptoms. Women more often present without chest pain and instead have neck pain, arm pain or feel tired. Among those over 75 years old, about 5% have had an MI with little or no history of symptoms. An MI may cause heart failure, an irregular heartbeat, cardiogenic shock or cardiac arrest.

<span class="mw-page-title-main">Coronary perfusion pressure</span>

Coronary perfusion pressure (CPP) refers to the pressure gradient that drives coronary blood pressure. The heart's function is to perfuse blood to the body; however, the heart's own myocardium must, itself, be supplied for its own muscle function. The heart is supplied by coronary vessels, and therefore CPP is the blood pressure within those vessels. If pressures are too low in the coronary vasculature, then the myocardium risks ischemia with subsequent myocardial infarction or cardiogenic shock.

<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.

A diagnosis of myocardial infarction is created by integrating the history of the presenting illness and physical examination with electrocardiogram findings and cardiac markers. A coronary angiogram allows visualization of narrowings or obstructions on the heart vessels, and therapeutic measures can follow immediately. At autopsy, a pathologist can diagnose a myocardial infarction based on anatomopathological findings.

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 currently 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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