What are the possible complications of a cardiomyopathy?
The severity of symptoms and the risk of complications vary greatly from patient to patient. Many patients have no major complaints for many years. Each patient with CM must be individually evaluated and advised to prevent and manage complications
The course of symptoms
Generally the type of symptoms, both mild and severe, tends to be stable, but they may increase over time, depending on the type of disease.
Drug and non-drug therapy can control symptoms and prevent their progression. In some patients, for example with Dilated cardiomyopathy (CMD), with dilation and reduction of the contractile force, it is even possible to return to normal with the available therapies. Conversely, in a minority of patients, slow or even sudden worsening can occur. It is always necessary to carry out periodic checks and promptly report new symptoms to the cardiologist, in particular dizziness or loss of consciousness (syncope) and reduction of effort capacity.
Le arrhythmia or cardiac irregularities are a common complication. They can be experienced as palpitations and be discovered with ECGDuring Stress test or with Dynamic ECG. Some arrhythmia (ex. ventricular tachycardia o atrial fibrillation), are important and require specific care.
Atrial fibrillation or flutter (AF)
This arrhythmia, which originates inlobbyusually presents with a heartbeat that is usually very rapid (e.g. 150 beats per minute), which can cause chest pain (Angina) or even acute heart failure (Pulmonary edema) in patients with CM. It can be occasional and spontaneously cease after a few minutes or several hours (Atrial fibrillation paroxysmal). It is frequent in patients with dilated atrium or atria and of advanced age. To avoid the FA antiarrhythmic drugs are indicated, or an electrical cardioversion to restore normal rhythm. If it recurs, ablation may be useful
Ventricular Tachycardia (VT)
These arrhythmias, which can arise suddenly and also last over time (Sustained TV), are threatening. They can cease spontaneously, perhaps after causing loss of consciousness (Syncope) or degenerate into a worse arrhythmia "Ventricular fibrillation", Leading to cardiac arrest, if not promptly stopped by an external defibrillator (DAE) or by a ICD.
It is favored by reduced levels of potassium in the blood, which must always be higher than 4 mEq / l
Through ECG dynamic episodes of TV not supported (TVNS lasting less than 30 ”). These are just one indicator of an increased risk of cardiac arrest
Cardiac Arrest (AC) and Sudden Death (MI)
Only a minority of patients encounter a Cardiac arrest, which, if not resuscitated, determines the sudden death (MI). It is more common in young people and if heart failure is present. Young age, along with other factors, such as the presence of threatening arrhythmias (TVNS o TV), of ventricular aneurysms, a juvenile MI (before age 50) in a member of the same family, may indicate the implantation of ICD to prevent this disastrous event. Arrest may be preceded by a few symptoms, the most important of which is sudden loss of consciousness ("syncope”), But there are often no warnings.
The individual risk assessment of AC e MI it's not easy. There are systems, however imprecise, to calculate the risk, but, due to its complexity, the assessment must be made by an expert cardiologist.
Sinoatrial (BSA) or atrioventricular (BAV) block
Rarely, the normal electrical signal may not be emitted regularly (BSA) or its transmission from the atria to the ventricles be slowed or blocked (BAV). This can lead to a slow heart rhythm (BAV second or third degree) and in these cases it may be necessary to implant a "Pacemaker" (PM), a pacemaker, under the skin, to restore normal emission or signal transmission from the atria to the ventricles.
It is the most frequent complication in CM patients. But it usually appears, with some exceptions, many years after diagnosis. Fortunately, today there are numerous therapies that allow to resolve or improve heart failure. In HCM obstructive, for example, can be resolved by the abolition of the obstruction with the reduction of the septum by "myectomy”And / or mitral plastic or with alcoholization of the septum. In DCM with Left broad branch block, with implantation of a PM with biventricular stimulation leading to resynchronization (CRT)
Intracavitary thrombosis (atrial or ventricular) and cerebral ("stroke") or peripheral embolism
In progress FA can be formed "thrombus"In the left atrium, and these can be carried by the bloodstream ("embolism") Or in a cerebral artery and cause cerebral ischemia ("ictus”) Or in a peripheral artery. More rarely, the thrombus can localize in the VS , especially if this is very dilated or if a "Apical aneurysm". In all these cases, and in relation to age and atrial dilation in the presence of FA, therapy is indicated anticoagulant (oral or with injections of Heparin subcutaneous) to avoid or try to dissolve the "thrombus"
It is a bacterial infection of a heart valve or of a foreign instrument such as eg. PM o ICD with their electrodes "stimulatorsInserted into the veins, or S-ICD, inserted under the skin. It occurs very rarely, especially if the valve is already damaged or intravenous injections are given in poor hygiene conditions (eg heroin, or other drugs). It manifests itself with episodes of continuous fever, even high. The bacterium can be identified and "cured" with adequate antibiotic therapy. It is also important to prevent it with antibiotic prophylaxis during major surgery. In some cases, it may be necessary to replace the valve or proceed to extract the PM / ICD and / or the electrode infected or S-ICD