Related Experiment Videos
Secondary and Infiltrative Cardiomyopathies
1Rush Heart Failure and Cardiac Transplant Program, Rush-Presbyterian-St. Luke's Medical Center, 1725 West Harrison Street, Suite 439, Chicago, IL 60612, USA.
Insights
Identifying the cause of secondary and infiltrative cardiomyopathies is crucial for effective treatment. Early diagnosis and targeted therapies, including updated heart failure regimens, offer the best chance for reversing ventricular dysfunction.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Secondary and infiltrative cardiomyopathies are rare and challenging to manage.
- Specific diagnosis is key, as removing causative agents can reverse ventricular dysfunction.
Purpose of the Study:
- To review current treatment strategies for secondary and infiltrative cardiomyopathies.
- To highlight evolving therapeutic approaches in heart failure management.
Main Methods:
- Review of current literature and clinical trial data.
- Discussion of diagnostic approaches and treatment modalities for various secondary cardiomyopathies.
Main Results:
- Standard heart failure therapy for dilated cardiomyopathy (DCM) is evolving with new drug classes.
- Infiltrative cardiomyopathies often require strict volume control and specific treatments like immunosuppression for myocarditis or corticosteroids for sarcoidosis.
- Iron chelation and phlebotomy are indicated for hemochromatosis-related cardiomyopathy.
Conclusions:
- Causative agent removal is paramount for secondary cardiomyopathies.
- Treatment requires tailored approaches based on the specific diagnosis.
- Emerging therapies like biventricular pacing and targeted molecular treatments show future promise.
Abstract:
Secondary and infiltrative cardiomyopathies are the least common forms of cardiomyopathy and often are the most difficult to treat. In all cases, efforts should be made to establish a specific diagnosis because the removal or avoidance of the causative agent (eg, alcohol, cocaine, persistent tachycardia) holds the best promise for reversal of ventricular dysfunction. Patients who present with a dilated cardiomyopathy (DCM) should be treated with standard heart failure therapy. However, the "standard" is changing and clinicians need to take heed of results of recent trials establishing the role of beta-blockers, aldosterone, and angiotensin receptor antagonists in addition to the regimen of digoxin, diuretics and angiotensin-converting enzyme (ACE) inhibitors. In contrast, patients who present with a more infiltrative clinical picture often manifest more diastolic dysfunction and need strict volume control to maintain euvolemia. For patients with biopsy-proven myocarditis, immunosuppressive therapy generally should be considered in an effort to maintain and potentially improve ventricular function. Patients with sarcoid heart disease have shown the greatest response to high-dose corticosteroids. Patients with hemochromatosis related cardiomyopathy should be treated with iron chelation therapy and phlebotomy. The role of cardiac transplantation is limited, as most of the secondary and infiltrative causes of cardiomyopathy are associated with an adverse posttransplant outcome. Other surgical options, such as left ventricular assist devices, may offer hope to patients who would otherwise be ineligible for cardiac transplantation. On the horizon, biventricular pacing and treatments targeted at cytokines and hormonal receptors hold the promise of improving symptoms and prolonging survival by counteracting the deleterious effects of these secondary mediators.