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Cardiomyopathy II: Dilated Cardiomyopathy

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Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
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Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
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Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...
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Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
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Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
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Mitral regurgitation (MR) is characterized by retrograde blood circulation from the left ventricle into the left atrium due to inadequate mitral valve closure. The severity of the condition, symptoms, and underlying cause determine treatment strategies.Monitoring and Pharmacological TreatmentPatients with mild to moderate MR typically do not need immediate intervention but regular monitoring to assess progression and guide treatment. Patients with mild MR should have an echocardiogram every 3-5...
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Related Experiment Video

Updated: Aug 7, 2025

Use of Two Intracorporeal Ventricular Assist Devices As a Total Artificial Heart
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HeartMate 3 biventricular support exceeding 4.5 years.

Hrvoje Gasparovic1, Davor Milicic2, Kristina Krželj1

  • 1University of Zagreb School of Medicine, Department of Cardiac Surgery, University Hospital Center Zagreb, Zagreb, Croatia.

ESC Heart Failure
|March 10, 2023
PubMed
Summary

This case study highlights a patient with ischemic cardiomyopathy who received durable biventricular assist device (BiVAD) support for over four years, achieving excellent quality of life before successful heart transplantation.

Keywords:
HeartMate 3 BIVADLong-term biventricular supportOutcome

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Area of Science:

  • Cardiology
  • Mechanical Circulatory Support
  • Heart Transplantation

Background:

  • Patient with ischemic cardiomyopathy and elevated pulmonary vascular resistance unsuitable for heart transplantation.
  • Initial implantation of a HeartMate 3 left ventricular assist device (LVAD) with temporary right ventricular assist device (RVAD).

Observation:

  • Transition to durable biventricular support (BiVAD) with two Heartmate 3 pumps due to unweanable RVAD support.
  • Patient maintained excellent quality of life and full activity for over 4 years on BiVAD support.
  • Experienced adverse events including subarachnoid hemorrhage, motor deficit, and RVAD infection with low-flow alarms.

Findings:

  • Outflow graft twist identified as the cause of RVAD flow reduction after prolonged support.
  • Successful heart transplantation achieved after 1655 days of Heartmate 3 BiVAD support.

Implications:

  • Demonstrates the long-term viability and effectiveness of durable biventricular assist device support in patients awaiting heart transplantation.
  • Highlights the potential for late complications such as graft issues and the importance of continued monitoring.
  • Suggests that BiVAD support can facilitate a high quality of life for extended periods, even in complex cardiac cases.