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Cardiomyopathy (Ref. Hari. 18th ed., Pg -1952)




  1. Inflamed myocardium from viruses (Coxsackie, polio, HIV, Lassa fever)
  2. Bacteria (Clostridia, diphtheria, Meningococcus, Mycoplasma. psittacosis)
  3. Spirochetes (Leptospirosis, syphilis, Lyme disease)
  4. Protozoa (Chagas disease)
  5. Vasculitis. 

Dilated cardiomyopathy


It is a Systolic dysfunction (LQ 2012) ( stroke volume / ↑ End diastolic volume = Ratio )

Pre disposing conditions

  1. Alcohol Q (AIPG 2006)
  2. Drugs doxorubicin, cyclophosphamide Q Cocaine, imatinib, trastuzumab
  3. Autoimmune
  4. Peri- or postpartum Q
  5. Congenital (x-linked) Q.
  6. Selenium deficiency Q
  7. Duchenne myopathy Q
  8. Freidrich’s ataxia
  9. Glycogen storage disease (Pompe’s disease) (AIPG 2010)

CF:  There are features of LVF and RVF


  1. CXR: cardiomegaly, pulmonary oedema
  2. ECG: tachycardia, non-specific T wave changes, poor R wave progression
  3. Echo: globally dilated hypokinetic heart and low ejection fraction. Q
  4. MR Q. TR Q, Mural thrombus Q.

Management: Bed rest, diuretics, digoxin, ACE-inhibitor, anticoagulation cardiac transplantation.

Restrictive cardiomyopathy (Ref. Hari. 18th ed., pg -1964)
It is a diastolics dysfunction (↓ stroke volume / ↓ End diastolic volume = ratio is normal or increased)

Causes: Q

  1. Amyloidosis
  2. Hemochromatosis (AIPG 2010)
  3. Sarcoid­osis;
  4. Scleroderma;
  5. Löffler’s (Eosinophilic cardiomyopathy)
  6. Endomyocardial fibrosis.

Features of RVF predominate:


Raised JVP, with prominent x and y descents, Kussmaul sign is positive Q; hepatomegaly; oedema; ascites.


Diagnosis: Cardiac catheterization.

Hypertrophic cardiomyopathy (HOCM) (Ref. Hari. 18th ed., pg -1962) It is a diastolic dysfunction

  1. Autosomal dominant inheritance Q  some times sporadic.
  2. Family history of sudden death may be there. (AIIMS Nov 12)

Symptoms & signs:

  1. Angina;                    
  2. Dyspnea              
  3. Palpitation;                  
  4. Syncope;    
  5. Jerky carotid pulsation Q;          
  6. ‘a’ wave in JVP;   
  7. Double apex beat Q (LQ 2012)
  8. Harsh ejection systolic murmur. Q The intensity of murmur increase on standing, Valsalva, Amyl nitrate inhalation Q (FAQ) (AIIMS Nov 12) 

Extra Edge:


Murmur of HOCM decreases with hand grip.






Echo: asymmetrical septal hypertrophy; small LV cavity with hypercontractile posterior wall; midsystolic closure of aortic valve; systolic anterior movement of mitral valve Q. (SAM)


  1. Beta-blockers or verapamil.
  2. Amiodarone for arrhythmias (AF, VT).
  3. Septal myotomy (surgical, or chemical. with alcohol Q,)

Drugs contraindicated (AIIMS Nov 10)

  1. Digoxin (LQ 2012)
  2. Nitrates       
  3. Beta agonist         
  4. Diuretics
Extra Edge:

In HOCM, angina is a symptom but here NO3 are contraindicated !!!.


Recent Advance: Tako-Tsubo (Stress) Cardiomyopathy (Ref. Hari. 18th ed., pg - 1964) (PNQ)

  1. Also known as apical ballooning syndrome.
  2. Characterized by the abrupt onset of severe chest discomfort preceded by a very stressful emotional or physical event.
  3. It occurs more commonly in women >50 years and is accompanied by ST-segment elevations and/or deep T-wave inversions in the precordial leads.
  4. No obstruction in the epicardial coronary arteries is noted on angiography.
  5. There is severe akinesia of the distal portion of the left ventricle with reduction of the EF.
  6. Troponins are usually mildly elevated. Cardiac imaging typically shows "ballooning" of the left ventricle in end-systole, especially of the LV apex.
  7. All of these changes, which are often quite dramatic, are reversible within 3–7 days and do not cause long-term cardiac dysfunction or disability.
  8. The mechanism responsible for Tako-tsubo cardiomyopathy is that an adrenergic surge that includes circulating catecholamines, acting on the epicardial coronary vessels and/or coronary microcirculation, is involved. Beta blockers are used in therapy 

Recent Advances: Arrhythmogenic RV Cardiomyopathy/Dysplasia (ARVCM/D) (Ref. Hari. 18th ed., pg - 1896) 

Naxos disease

  1. A distinct genetic form of this syndrome is Naxos disease.
  2. It consists of arrhythmogenic RV dysplasia coupled with palmar-plantar keratosis and woolly hair.
  3. It is associated with a high risk of SCD in adolescents and young adults.

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