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Cardiomyopathy: Framingham Heart Study

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The existence of cardiomyopathy was first proposed by Rubler et al, In 1974 Framingham study showed that heart failure was more common in diabetes due to diabetes cardiomyopathy.58,59 The Framingham heart study reveals a marked in congestive heart failure, coronary artery disease and myocardial infarction in diabetes patients.60
Diastole is that phase of the of the cardiac cycle when the heart is not contracting to propel blood out (systole) to the body, brain and lungs but instead is relaxing and filling with incoming blood that is being return from body through inferior vena cava from lungs through the pulmonary veins and the through superior vena cava. Diastole begins with aortic valve closure and ends with mitral valve closure. Diastole …show more content…

Diastolic dysfunction has a major impact on symptoms status, functional capacity, medical treatment and prognosis in both systolic and diastolic heart failure (HF) irrespective of the cause.
Pathophysiology of LVDD:- Diastole is divided into four physiological phases:
1. Isovolumetric relaxation: from closure of the aortic valve to opening of …show more content…

Left atrial enlargement with associated AF provides an easily identifiable indicator of LVDD and need for further echocardiography evaluation.
1- Trans mitral flow velocity: the early diastolic peak filling velocity when the transmitral pressure gradient is greatest generates the E wave velocity on the echocardiography. The late diastolic peak filling velocity associated with atrial contractions generates the A wave velocity. Because normal atrial contribution to total to total diastolic filling is only 30%, a normal A wave is smaller than E wave with a ratio >1. LVDD initially produces smaller E wave and a high with reversal of the E:A ratio. As disease progress the E wave increase until E/A ratio are >1.5. During the process of this transition, the E/A ratio will temporarly normalize despite the presence of moderately severe disease. This is referred to as pseudo-normalizations and highlights a limitation to sole use of E/A ratio for diagnosis.
2- Pulmonary venous flow (PVF): Atrial relaxation (x-descent) and LV diastole (y-descent) causes forward PVF. In LVDD, PVF reversal associated with atrial contraction becomes progressively more pronounced as LAP

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Figure 1 shows the electrocardiogram (ECG) after the angiography. A carotid endarterectomy was performed 5 months before due to an atheroembolic stroke. During the postoperative period, she presented atrial fibrillation with rapid ventricular response and amiodarone was added to her habitual treatment. Her current treatment is ASA 325 mg/day, atenolol 50 mg bid, enalapril 20 mg bid and amiodarone 200 mg bid. One month before the event she attended the outpatient clinic and an echocardiogram was performed, which showed: normal left ventricular dimensions, wall thickness mildly increased, normal left atrium and aorta, mild left ventricular dysfunction with an estimated ejection fraction of 50%, hypokinetic basal inferior and mid inferior segments and mitral inflow filling pattern of delayed relaxation (according to her age).

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Generate: Heart auscultation is useful in characterizing heart sounds and identifying abnormalities that may suggest cardiac dysfunction.1 The fourth heart sound (S4 atrial gallop), heard during the patient’s physical examination, is often an abnormal finding due to reduction in ventricular wall compliance.1,2 Additionally, S4 occurs due to rapid deceleration of active blood flow due to a nondistensible ventricle.2 S4 can be heard in patients with hypertension, hypertrophic cardiomyopathy and acute myocardial infarction (AMI).1,2

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Normally, low-oxygen blood entering the right side of the heart stays on the right side, and subsequently oxygen-rich blood stays on the left side of the heart, where it is then pumped to the body and tissues. When a defect or "hole" is present between the atria (or upper chambers of heart), some oxygen-rich blood leaks back to the right side of the heart. It then goes back to the lungs even though it is already rich enough in oxygen. Because of this, there is a significant increase in the blood that goes to the lungs overall. Atrial septal defects can

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1) In mitral stenosis a diastolic murmur is present due to stenosis, or narrowing of the valve. The murmur is heard when the mitral valve fails to open appropriately in diastole. The leaflets of the valve are usually thicker, stiffer, and become misshapen from the effects of rheumatic fever or a congenital defect (Porth, 2011). The crackles in her lungs are likely due to left sided heart failure leading to pulmonary hypertension.

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Metabolism seems linked to rapid or irregular heart beats that is seen in atrial fibrillation and its development has been seen in patients with thyroid gland disorder, hyperthyroidism, in which an excess of thyroid hormone is produced, with signs of fast heartbeats. Atrial fibrillation are commonly associated with different cardiovascular diseases, or may not be linked to any heart disorders at all. The progress of atrial fibrillation has been linked to the following cardiovascular disorders: coronary artery disease, pericarditis, congenital heart disease, problems with valves: mitral stenosis and mitral regurgitation. Also, there are myocardial enlargements that are associated with atrial fibrillation including hypertrophic cardiomyopathy and left atrial enlargement.[2 ]

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The pumping ability of the heart is compromised by a continuum between coronary artery disease, myocardial ischemia, and myocardial infarction. This paradox deprives the heart of blood-borne oxygen and nutrients. Coronary artery disease (CAD) is the earliest of the continuum and consists of any disorder that narrows or blocks the coronary arteries. Atherosclerosis is the most common cause of CAD, which diminishes the myocardial blood supply until the blood flow to the heart is limited causing the starvation of cells or ischemia. (McCance 1160).

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Because of this inability to contract effectively, the rest of the vital organs receive inadequate amount of blood resulting to inadequate tissue perfusion. There are two types of left-sided HF; systolic and diastolic failure. Systolic failure happens when the left ventricle doesn’t have the enough energy to pump normally the blood to the general circulation. As for diastolic failure, the left ventricle loses the ability to fill itself with blood during resting period resulting to inadequate amount of blood to be pumped out to the circulation (Weinrauch, 2008). The diastolic dysfunction will eventually lead to right-sided heart failure.

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Long axis (L) length is measured in apical 4-chamber view from the apex to the mid-point of the mitral valve at end-diastole, and short axis (S) length is measured as the axis that perpendicularly intersects the mid-point of the long axis [76,79]. A decrease in the index of sphericity to less than 1.5 would support LV dilation and eccentric remodeling [84]. The relationship between the left ventricular chamber dimensions and body weight is not linear, so SI may be useful to tell if the left ventricle is dilated or not [76].

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The heart is one of the most important organs in the body, but unfortunately heart disease can weaken the cardiovascular system which could lead to fatal effects on this vital organ. The heart is the strongest organ in the body, pumping blood 70 times a minute (Avoiding Heart Attacks and Strokes), so if it becomes damaged, consequently the whole body becomes damaged (Allen 34). More than 60 million Americans suffer from some sort of cardiovascular disease (“Heart Disease”). Heart disease and heart attacks are cardiovascular problems because the effects it can leave on the heart and blood vessels are so horrific it can lead someone to their death, but fortunately there are many ways one can make changes in their life in order to avoid these

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