KARDIOMYOPATI

dr. Erlina Marfianti, MSc, SpPD

Dept. Ilmu Penyakit Dalam FK UII YK
 Definisi
 Suatu kelompok penyakit yang mengenai
langsung pada otot jantung itu sendiri,
yang bukan terjadi karena kondisi lain
akibat perikarditis, koroner, hipertensi,
penyakit kongenital, penyakit katup.
 Menyebabkan disfungsi / kehilangan
kemampuan untuk
Etiologi
 Kebanyakan kasus adalah idiopatik
 Merupakan 30 % penyebab kematian jantung
 Perkembangan ilmu  genetik
 Berdasarkan etiologi diklasifikasikan menjadi 2
tipe:
 Tipe primer : bila penyebabnya tidak diketahui
(idiopatik kardiomiopati, familial kardiomiopati)
 Tipe skunder: bila diketahui ada penyakit miokardium
yang penyebabnya tidak diketahui
 Klasifikasi
 Berdasarkan klinis dan patologis dibagi
menjadi 3, yaitu:
 Kardiomiopati hipertrofik
 Kardiomiopati Restriktif
 Kardiomipati Dilatasi
 Dilated (congestive) cardiomyopathy

 This is the most common form. In it, the heart

cavity is enlarged and stretched (cardiac
dilation).
 The heart is weak and doesn't pump normally,
and most patients develop heart failure.
 Abnormal heart rhythms called arrhythmias and
disturbances in the heart's electrical conduction
also may occur.
 Penyebab
Paling sering: penyebabnya tidak diketahui,
• genetik
• Autoimun disease, amiloidosis, sarkoidosis, DM
 SYMPTOMS OF CARDIOMYOPATHY

 Shortness of breath
 Swelling of the ankles
 Tiredness
 Palpitations and fainting
 Chest pain

Physical examination:
Cardiomegaly, S3 gallop, a murmur
fucntional mitral regurgitation.
 Diagnosis
 Electrocardiogram (ECG)
 • Echocardiogram
 • Chest X-ray
 • Holter Monitor or 24 hour tape
 • Exercise test
 • Blood tests
 Cardiac Cateterization
 Biopsy myocardial
The ECG may show changes that indicate heart muscle damage,
but not necessarily the cause of this damage.
In DCM the ECG abnormalities are not specific and may also be found in other condition

• Low QRS Voltage

•Non spesific repolarisation
•Intraventrikular conduction
abnormalities
Figure 3
Electrocardiogram or ECG
Echocardiogram or echo

An echocardiogram is an ultrasound scan of the heart (figure 4).

A picture of the heart is produced from which an accurate assessment of the size and function of
the heart can be made.
This is the most important test in DCM as it confirms the presence of an enlarged and poorly
functioning heart.

                                                                                                                                                               

Figure 4
Echo machine
 Treatment
 Spesific therapy underlying caused
 Sesuai heart failure:
 ACE Inhibitors (such as Captopril, Enalapril, Lisinopril, Enalapril and
others).
 Beta-blockers (such as Metoprolol, Carvedilol, Bisoprolol and
others)
 Digoxin
 Diuretics (such as Frusemide, Bumetamide, Amiloride and others)
 Spironolactone
 Warfarin
 Amiodarone

Other therapies
Cardioversion
 Heart transplant
 Pacemaker
COMPLICATIONS

 Heart failure
 This is a common feature of DCM. It occurs when the muscle of the heart is
not strong enough to pump blood efficiently round the body, causing build up
of fluid in the lungs and /or the tissues.

 Atrial fibrillation (AF)

 This is a very common abnormal rhythm in DCM. The heart beat is irregular
and rapid, and causes palpitations, increasing shortness of breath and
fatigue. It can be associated with sudden deterioration of symptoms or the
development of blood clots (emboli). The risk of clots means that warfarin
medication is usually used to thin the blood if atrial fibrillation occurs.
 
 Blood clots
 In DCM the blood flow through the heart is slower than normal. This may
allow blood clots to form in the heart. If a blood clot dislodges from these
sites and goes into circulation, it can cause damage to the brain (a stroke).
Therefore, some people with DCM ,especially those with very enlarged
hearts, may need to be treated with anticoagulant medication (warfarin), to
prevent such clots from forming.
 Rhythm disorders
 These generally cause dizziness,
breathlessness, palpitations (awareness of the
heartbeat), or may cause no symptoms. Some
rhythm disorders that may occur in DCM are:

 Ventricular ectopics
 Ventricular tachycardia (VT)
 Ventricular fibrillation (VF)
 Sudden death
 Heart block
hypertrophic cardiomyopathy
 hypertrophic cardiomyopathy
In this condition, the muscle mass of the left
ventricle enlarges or "hypertrophies."
 In one form of the disease, the wall (septum)
between the two ventricles (pumping chamber)
becomes enlarged and obstructs the blood flow
from the left ventricle. The syndrome is known
as hypertrophic obstructive cardiomyopathy or
asymmetric septal hypertrophy 
 It's also called idiopathic hypertrophic subaortic
stenosis
 Symptoms

Chest pain
Dizziness
Fainting, especially during exercise
Heart failure (in some patients)
High blood pressure (hypertension)
Light-headedness, especially after activity or exercise
Sensation of feeling the heart beat (palpitations)
Shortness of breath
Other symptoms that may occur are:
Fatigue, reduced activity tolerance
Shortness of breath when lying down

Some patients have no symptoms.

They may not even realize they have the condition
until it is found during a routine medical exam.
 Diagnosis
 Tests used to diagnose heart muscle thickness, problems with blood
flow, or leaky heart valves (mitral valve regurgitation) may include:
 24-hour Holter monitor (heart monitor)
 Cardiac catheterization
 Chest x-ray
 ECG
 Echocardiography (the most common test) with Doppler
ultrasound
 MRI of the heart
 Transesophageal echocardiogram (TEE)
 Blood tests may be done to rule out other possible diseases.
 If you are diagnosed with hypertrophic cardiomyopathy, your health
care provider may recommend that your close blood relatives
(family members) be screened for the condition
 Treatment

The goal of treatment is to control symptoms and prevent complications.

Some patients may need to stay in the hospital until the condition is under control
(stabilized).
If you have symptoms, you may need medication to help the heart contract and
relax correctly.
Drugs include beta-blockers and calcium channel blockers. These medicines
reduce chest pain and pain during exercise. Medications will often relieve
symptoms so patients do not need more invasive treatments.
Some people with arrhythmias may need anti-arrhythmic medications. If the
arrhythmia is due to atrial fibrillation, blood thinners will also be used to reduce
the risk of blood clots.
Some patients may have a permanent pacemaker placed. However, pacemakers
are used less often today than they were in the past.
Restrictive cardiomyopathy is a disorder of the heart muscle in which the
walls of the ventricles become stiff, but not necessarily thickened, so they
resist normal filling with blood.

Impaired diastolic filling with preserved contractile function

 Etiologi
 idiopathic (its cause isunknown)
 systemic disorders such as:
 endomyocardial fibrosis (tropical, hypereosinophic syndrome),
 infiltrative disorders (amyloidosis, sarcoidosis), and
 rare metabolic disorders (Gaucher's disease,
Mucopolysaccharidoses, Fabry's disease, carcinoid syndrome).
 Restrictive cardiomyopathy is also described following
radiation therapy for some types of cancer.
 Patients with the idiopathic form may have a family
history of cardiomyopathy. Recent evidence suggests
that the disease may be caused by the same genetic
abnormalities
Restrictive Cardiomyopathy
This is the least common type in
the United States.
The myocardium (heart muscle) of
the ventricles becomes excessively
"rigid," so it's harder for the
ventricles to fill with blood between
heartbeats.
A person with restrictive
cardiomyopathy often complains of
being tired, may have swollen
hands and feet, and may have
difficulty breathing on exertion.
This type of cardiomyopathy is
usually seen in the elderly and may
be due to another disease process.
 Symptomp
 Patients with RCM have signs and/or symptoms
of heart failure such as fatigue, shortness of
breath, tissue swelling (oedema) and abdominal
enlargement.
 Up to a third of patients may have an embolic
complication, such as a blood clot. 
 Abnormal heart rhythms and palpitations are
common whatever the underlying cause of the
disease
 Diagnosis
 The diagnosis of RCM is usually based on a physical
examination, an electrocardiogram (ECG) and an
echocardiogram.
 Magnetic resonance imaging (MRI) can provide
additional information about the structure of the heart.
 In some patients a precise diagnosis may require
catheterisation of the heart to measure pressures and
 a biopsy of the heart muscle (removal and microscopic
examination of a specimen), which may enable the
doctor to identify the infiltrating substance.
Treatment
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