Saturday, February, 11, 2012

Ischemic cardiomyopathy

Table of Contents

Alternative Names

Ischemic heart disease; Cardiomyopathy - ischemic


Symptoms

Patients with ischemic cardiomyopathy often have symptoms of angina or heart failure.

Symptoms of angina include:

  • Chest pain that occurs behind the breastbone or slightly to the left of it. It may feel like tightness, heavy pressure, squeezing, or crushing pain. The pain may spread to the neck, jaw, back, shoulder, or arm.
  • Dizziness or light-headedness
  • Feeling of indigestion or heartburn
  • Nausea, vomiting, and cold sweats
  • Sensation of feeling the heart beat (palpitations)
  • Shortness of breath
  • Unexplained tiredness after activity (more common in women)

Symptoms of heart failure usually develop slowly over time. However, sometimes symptoms start very suddenly and are severe. Common symptoms include:

  • Awakening from sleep after a couple of hours due to shortness of breath
  • Cough
  • Fatigue , weakness , faintness
  • Loss of appetite
  • Pulse may feel irregular or rapid, or there may be a sensation of feeling the heart beat (palpitations)
  • Shortness of breath, especially with activity
  • Shortness of breath that occurs after lying down
  • Swelling of feet and ankles (in adults)
  • Swelling of the abdomen (in adults)

Signs and tests

The physical examination may be normal, or it may reveal signs of fluid buildup:

  • "Crackles" in the lungs (heard with a stethoscope)
  • Elevated pressure in the neck vein
  • Enlarged liver
  • Extra heart sounds
  • Leg swelling

There may be other signs of heart failure.

This condition is usually diagnosed only if a test shows that the pumping function of the heart is too low. This is called a decreased ejection fraction. A normal ejection fraction is around 55 - 65%. Most patients with this disorder have ejection fractions much less than this.

Ischemic heart disease can make people more likely to have heart failure and the symptoms and signs noted above when the ejection fraction is normal or near normal. This is due to the abnormal relaxation of the heart (impaired filling). This is sometimes called "diastolic heart failure" or "heart failure with preserved ejection fraction."

Tests used to measure ejection fraction include:

  • Echocardiogram
  • Gated SPECT
  • MRI of heart
  • Ventriculogram performed during a cardiac catheterization

Biopsy of the heart is needed in rare cases to rule out other disorders.

Lab tests that may be used to rule out other disorders and assess the condition of the heart include:

  • Blood chemistries
  • Cardiac biochemical markers (CK-MB, troponin)
  • CBC
  • Coronary risk profile (including blood lipid levels)

Review Date: 05/17/2010
Reviewed By: Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)