Dilated, Restrictive, Infiltrative

and hypertrophic Cardiomyopathies

Department of Cardiology,
The first affiliated hospital of NJMU

Zhixin JIANG, MD, PHD

E-mail: zhixin_jiang@njmu.edu.cn
•Morphology
•Causes
•Genes
•Therapy
DCM morphology change
Causes
Causes-continued
Gene types
Therapy for Dilated Cardiomyopathy

• Therapy for DCM is similar to that for all types of systolic dysfunction
Arrhythmogenic Cardiomyopathy
RV晚电位的消融

0.1-0.4mV
VT1消融终⽌

0.1-0.4mV
Tachycardia-Induced Cardiomyopathy

AF+WPW
 post-RFCA
LVEF 30% to 55
 Peripartum Cardiomyopathy

• Mostly in the first month after delivery

Risk Factors

• Age

More than 50%: women >30 years;

10 times: >40 versus <20 years.

 Pathophysiology

• Hemodynamics

Blood volume↑
Red blood cell mass ↑
Preload ↑
Cardiac output ↑ ( 20% to 50%)
Heart rate ↑ (15% to 30%)
Stroke volume ↑ (15% to 25%)
Treatment

• Diuretic agents: avoid hypotension and impaired uterine perfusion

before delivery

• ACEI/ARB: contraindicated before delivery

• β-Blockade: safe during pregnancy (Metoprolol)

• Digoxin: safe during pregnancy

Takotsubo Cardiomyopathy
 Takotsubo Cardiomyopathy

➢ 危险因素

• 情绪压⼒（2/3）

• 躯体疾病压⼒（28%）

• 绝经后⼥性（90%）

• ⼼理疾病（抑郁症）

• 基因遗传？（L41Q多态性和GRK5突变）
 Takotsubo Cardiomyopathy

➢ 典型表现

• 类似ACS表现（胸痛、呼吸困难、晕厥）

• ⼼电图异常：ST段抬⾼、T波倒置、QT延⻓、异常Q波

• 肌钙蛋⽩：轻度升⾼（74-86%）

• 严重并发症：急性左⼼衰、⼼室破裂、左室⾎栓形成、左室流出道压⼒阶差变
化、TdP
 Takotsubo Cardiomyopathy
•Revised Mayo clinic的诊断标准
1.短暂性左⼼室中部（累及或不累及⼼尖部）⽆运动或运动减弱，室壁运动异常
的范围超出单⽀冠状动脉供⾎的范围。起病前常常有应激，但应激并⾮必要条
件。

2.CAG:⽆冠状动脉堵塞或急性斑块破裂的依据。

3.新发的ECG异常：ST抬⾼，伴或不伴T波倒置，肌钙蛋⽩中度升⾼。

4.除外嗜铬细胞瘤及⼼肌炎

• 以上四条均满⾜时可考虑诊断应激性⼼肌病。
 Takotsubo Cardiomyopathy

➢治疗
• 未明确诊断，按ACS处理

• 严重⼼衰：利尿、扩⾎管、正性肌⼒药（PDEI）、IABP

• β受体激动剂和⼉茶酚胺类正性肌⼒药物(多巴胺、多巴酚丁胺) 禁忌

• 严重室壁运动障碍合并发⾎栓栓塞症危险：抗凝
 RESTRICTIVE AND INFILTRATIVE
CARDIOMYOPATHIES

• Cardiac Amyloidosis
• Sarcoid Cardiomyopathy
Cardiac Amyloidosis
Sarcoid Cardiomyopathy
LVOT obstruction