Cardiomyopathies (DCM, HOCM, RCM)- definition,etiology, classification, symptoms, diagnosis, differential diagnosis treatment
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dilated cardiomyopathy echocardiography gross pathology
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hypertrophic obstructive cardiomyopathy HOCM septal hypertrophy echocardiography
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restrictive cardiomyopathy amyloidosis cardiac histology
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This is a comprehensive review of all three major cardiomyopathies. Here's a quick orientation to the content:
What's covered for each (DCM, HOCM, RCM):
- Definition & epidemiology — prevalence, demographics
- Etiology & classification — genetic (specific genes/mutations) and acquired causes
- Pathology — gross and microscopic findings with images
- Symptoms — from early to advanced, plus classic examination findings
- Diagnosis — ECG, echo (with images), MRI, catheterization, labs, genetic testing
- Differential diagnosis — including the critical RCM vs. constrictive pericarditis table
- Treatment — pharmacotherapy, device therapy, surgical/interventional options, and disease-specific therapies
Key clinical pearls to remember:
- DCM murmur is functional MR (pansystolic); does not change with Valsalva
- HOCM murmur increases with Valsalva and decreases with squatting — opposite of AS
- RCM vs constrictive pericarditis: LVEDP > RVEDP by ≥5 mmHg in RCM (equalize in CP); annulus paradoxus (high e') is seen in CP not RCM
- Avoid in HOCM: vasodilators, diuretics, digoxin, dihydropyridine CCBs — all worsen LVOTO
- Avoid digoxin in amyloidosis: binds amyloid fibrils → toxicity even at "therapeutic" levels
- Mavacamten is the first cardiac myosin inhibitor approved specifically for symptomatic HOCM
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