Cardiomyopathy restrictive

Cardiomyopathy (e.g., dilated myopathy, hypertrophic cardiomyopathy, restrictive myopathy)... 

Long-term chloroquine can cause cardiac comphca-tions, such as conduction disorders and cardiomyopathy (restrictive or hypertrophic), by structural alteration of the interventricular septum (4). Thirteen cases of cardiac toxicity associated with long-term chloroquine and hydroxychloroquine have been reported in patients with systemic autoimmune diseases. The cumulative doses were 600-2281 g for chloroquine and 292-4380 g for hydroxychloroquine. 

Cheng, L., Ding, G., Qin, Q., et al. (2004) Cardiomyocyte-restricted peroxisome proUferator-activated receptor-delta deletion perturbs myocardial fatty acid oxidation and leads to cardiomyopathy. Nat. Med. 10,1245-1250. 

Patients with pericardial tamponade, restrictive cardiomyopathy, constrictive pericarditis, solutions containing dextrose in patients with known allergy to corn or corn products (IV). 

The relationship between dietary or caloric intervention and life span has been characterized in rodents. Restriction of the protein component without CR suppresses the development of both nephropathy and cardiomyopathy [6], and restriction of the fat component without CR also suppresses nephropathy [7] however, neither markedly retards the aging processes or extends the life span [7, 8], Thus, restricting protein, fat, or mineral components without CR suppresses certain specific age-related pathology but does not markedly influence the aging processes or life span. 

A 64-year-old woman with systemic lupus erythematosus took chloroquine for 7 years (cumulative dose 1000 g). She developed sjmcope, and the electrocardiogram showed complete heart block a permanent pacemaker was inserted. The next year she presented with biventricular cardiac failure, skin hyperpigmentation, proximal muscle weakness, and chloroquine retinopathy. Coronary angiography was normal. An echocardiogram showed a restrictive cardiomyopathy. A skeletal muscle biopsy was characteristic of chloroquine myopathy. Chloroquine was withdrawn and she improved rapidly with diuretic therapy. 

Restrictive cardiomyopathy due to endocardial fibrosis occurred in a 35-year-old woman 5 months after she had started to take fenfluramine 10 mg tds and phentermine 15 mg/day (7). The endocardial findings strongly resembled the valvular lesions associated with the use of fenfluramine-phentermine. Endocardial and valvular fibrosis associated with anorectic drugs is strikingly similar to the plaque material found in patients with carcinoid syndrome and those exposed to methysergide, and all possibly arise from a common mechanism. 

Liao P, Georgakopoulos D, Kovacs A, et al. The in vivo role of p38 MAP kinases in cardiac remodeling and restrictive cardiomyopathy. Proc Natl Acad Sci USA 2001 98 12,283-12,288. 

In dilated cardiomyopathy, the cardinal feature is dilatation of the ventricles. Systohc fnnction is abnormal, leading to a decreased cardiac ontpnt. Inpatients with hypertrophic cardiomyopathy (HCM), the ventricnlar cavity is not dilated, and the ventricnlar mnscle mass is increased. Ventricnlar cavity size is normal or decreased, and systolic function often is preserved. Patients with HCM may have an obstructive or nonobstructive form. Patients with restrictive cardiomyopathy have inadequate ventricular comphance causing diastolic dysfunction owing to endocardial and/or myocardial disease. The chnical presentation is similar to that of constrictive pericarditis. 

Restrictive cardiomyopathy is primarily an abnormality of diastolic function that results in impaired filling and increases in ventricular end-diastolic pressures with normal or decreased diastolic volume. It is associated with normal systolic function early in the course of the disease but a decrease in systolic function later in the disease... 

Restrictive cardiomyopathy is the type of cardiomyopathy encountered least frequently in Western countries. Since the occurrence... 

Restrictive myocardial disease may result from several local or systemic disorders. Amyloidosis, hemochromatosis, scleroderma, carcinoid, sarcoidosis, diabetes, pseudoxanthoma elasticum, and endomyocardial fibrosis have been known to cause restrictive cardiomyopathy. The most common cause of restrictive cardiomyopathy in the industrialized world is amyloidosis, whereas endomyocardial fibrosis is a common cause in tropical areas of the world. There may be a genetic predisposition to idiopathic restrictive cardiomyopathy. ... 

The major hemodynamic abnormality in restrictive cardiomyopathy is a limitation in ventricnlar filling leading to increased filling pressnres. The cavity size and wall thickness of the ventricles are usually normal. Atrial dimensions often are increased. Thrombi are found freqnently in the cardiac chambers. Patients have signs and symptoms consistent with CHF. The abnormality is similar to what is seen in pericardial disease cansing constriction or tamponade. 

The diagnosis of restrictive cardiomyopathy should be considered in any patient who presents with signs and symptoms of CHF but has only mild cardiomegaly. Differentiation from constrictive pericarditis is important because pericardectomy is an effective form of treatment for constrictive pericarditis. 

The treatment of restrictive cardiomyopathy is complex becanse of the heterogeneity of the pathophysiologic abnormalities. Dinretics are used for the symptoms of venous congestion in the presence of restrictive cardiomyopathy, but caution is advised because these patients require high filling pressures to maintain an adequate stroke volume and cardiac output. Hypotension and hypoperfusion may occur as a result of the excessive use of diuretics. Because systolic function is often normal, digoxin is of little benefit and may be proarrhyth-... 

Weller RJ, Weintraub R, Addonizio LJ, et al. Outcome of idiopathic restrictive cardiomyopathy in children. Am J Cardiol 2002 90 501-506. 

Berger, P. B., Duffy, J., Reeder, G. S., Karon, B. L., and Edwards, W. D., Restrictive cardiomyopathy associated with the eosinophilia-myalgia syndrome, Mayo Clin. Proc., 69, 162, 1994. 

WHO group II patients with pulmonary venous hypertension include patients with systolic heart failure, preserved ejection fraction heart failure (PEFHF), valvular heart disease, and hypertrophic, restrictive, or infiltrative cardiomyopathies. Particular care should be... 

Salt restriction, as the basic treatment of congestive HE, can explain, at least in part, the relatively higher incidence of dilated cardiomyopathy in geographic areas of chronic iodine deficiency. 

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