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Myocardial Diseases


Cardiomyopathy: Heart disease resulting from primary abnormality in the myocardium 3 pattern

  1. Dilated cardiomyopathy - m. comm. 90% f cases
  2. Hypertrophic cardiomyopathy
  3. Restrictive cardiomyopathy -least prevalent. 

Dilated cardiomyopathy:

  1. Progressive Cardiac hypertrophy, dilation & contractile (systolic) dysfunction, LVEF < 40%
  2. Congestive cardio myopathy  

Causes: a. Idiopathic, b. alcohol c. peripartum,Q d. genetic (deletion/ mutation in mitochondrial gene for oxidative phosphorylation, genes for (3 oxidations of fatty acids, gene for dystrophin) e. viral myocarditis, f. hemochromatosis,  g. chronic anemia, h. doxorubicin, sarcoidosisQ


Morphology - Heart   Heavy (2-3 X (n) weight), large, flabby with dilation

Death: Progressive cardiac failure or arrhythmia


Functional Pattern

Left Ventricular Ejection Fraction*

Mechanisms of Heart Failure



Impairment of contractility (systolic dysfunction)


50% to 80%

Impairment of compliance (diastolic dysfunction)


45% to 60%

Impairment of compliance (diastolic dysfunction)



Hypertrophic cardiomyopathy –

  1. Idiopathic hypertrophic subaortic stenosis
  2. Hypertrophic obstructive cardiomyopathy
  3. Diastolic dysfunction Q, LVEF: 50-80% Heart, Heavy,  muscular, hyper contracting
  4. L V outflow obstructions: is 1/3
  5. Disproportionate thickening of ventricular septum as compared with free wall of LV
  6. Asymmetrical septal hypertrophy, banana like configuration (most prominent in subaortic region) Q 

Pathogenesis: ADQ

Genetic defects comprise mutations in anyone of the 4 genes Q that encode cardiac contractile elements; (β-myosin heavy chain, myosin binding protein C, - tropomyosin, cardiac troponin - T


Restrictive Cardiomyopathy:

  1. Ventricular compliance              
  2. Idiopathic or associated with disease
  3. Radiation fibrosis Q                                               
  4. Amyloidosis Q
  5. SarcoidosisQ                                                  
  6. Metastatic tumors Q
  7. Ventricles (n) / slightly No. dilation 

Other Restrictive conditions:


1.  Endomyocardial fibrosis: Q

  1. Children - young adults
  2. Tropics, Africa
  3. Fibrosis of ventricular endocardium &Subendocardium
  4. Extending from apex to M V & TV

2.  Loefflerendomyocarditis: Endomyocardial fibrosis, typically with large mural thrombi with eosinophilia



3.  Endocardialfibroelastosis: Focal/diffuse fibroelastic thickening, involving mural LV endocardium.

  1. m. comm. in first 2 yrs. of life 


  1. Congenital anomaly             
  2. Berry aneurysm
  3. A V fistula                    
  4. Arteriosclerosis:
  5. Hardening of arteries thickening with loss of elasticity

4. patterns

a.  Atherosclerosis

b.  Monckeberg medial calcific sclerosis Q

  1. Involving medium sized muscular arteries
  2. Patient> 50 years of age
  3. Visible on x-ray                             
  4. Asymptomatic

c.   Arteriolosclerosis Q

  1. Of small arteries & arterioles
  2. Hyaline & hyperplastic  
  3. Associated with HT, DM

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