Dysmetabolic cardiomyopathy

Dysmetabolic cardiomyopathy is a heart disease that develops as a result of metabolic abnormalities in the body. It is often associated with various metabolic syndromes including type 2 diabetes mellitus, obesity, atherosclerosis and hypertension. This disease is associated with metabolic abnormalities and cardiac function.

Here are the main characteristics of dysmetabolic cardiomyopathy:

1. Insulin resistance: One of the key factors in the development of this form of cardiomyopathy is insulin resistance, where the body's cells become less sensitive to the action of insulin. This is often associated with type 2 diabetes and can lead to high blood sugar levels.
2. Obesity: Obesity plays a major role in dysmetabolic cardiomyopathy. It can cause insulin resistance, increase cardiac workload, and contribute to other metabolic disorders.
3. Atherosclerosis: A buildup of cholesterol and fatty deposits in the arteries, called atherosclerosis, may also be part of this form of cardiomyopathy. Atherosclerosis impairs the blood supply to the heart and increases the risk of heart complications.
4. Hypertension: High blood pressure is a frequent associated problem of dysmetabolic cardiomyopathy and can have a negative impact on cardiac function.

Symptoms of dysmetabolic cardiomyopathy can range from mild to severe and include fatigue, shortness of breath, chest pain, arrhythmias, and other symptoms associated with heart dysfunction.

Treatment of dysmetabolic cardiomyopathy usually involves managing major metabolic risk factors such as weight loss, controlling blood pressure and blood sugar levels, and managing symptoms and complications of the heart lesion. Patients with this condition are advised to work with their physician to develop an individualized treatment and management plan.

Causes of the dysmetabolic cardiomyopathy

Examples of metabolic changes that may contribute to the development of dysmetabolic cardiomyopathy are:

1. Diabetes mellitus: Type 1 and type 2 diabetes can cause high blood sugar levels, which can damage blood vessels and heart muscle. Elevated sugar levels can also lead to atherosclerosis (cholesterol deposits) in the arteries that supply blood to the heart.
2. Hypertension (arterial hypertension): Persistent high blood pressure can damage blood vessel walls and impair blood supply to the heart, which can eventually cause dysmetabolic cardiomyopathy.
3. Obesity: Overweight and obesity are often accompanied by changes in lipid and glucose metabolism, which increases the risk of dysmetabolic cardiomyopathy.
4. Dyslipidemia: High cholesterol (especially low-density lipoprotein, LDL) and/or low high-density lipoprotein (HDL) levels in the blood may contribute to atherosclerosis and resulting dysmetabolic cardiomyopathy.
5. Metabolic syndrome: Metabolic syndrome is a complex of symptoms including obesity, hypertension, glucose metabolism disorders and dyslipidemia. This syndrome significantly increases the risk of developing dysmetabolic cardiomyopathy.
6. Sleepapnea syndrome: Sleep apnea is a disorder in which normal breathing during sleep is disrupted. This can lead to hypoxia (lack of oxygen) and stress on the heart, which can impair its function.
7. Thyrotoxicosis: Hyperfunction of the thyroid gland resulting in increased levels of thyroid hormones (thyrotoxicosis) can cause changes in heart rhythm and heart function.

Dysmetabolic cardiomyopathy usually develops as a result of the long-term effects of these factors on the heart and blood vessels. It is important to control risk factors such as diabetes mellitus, arterial hypertension, obesity and dyslipidemia to prevent the development of this condition.

Pathogenesis

The pathogenesis of dysmetabolic cardiomyopathy is related to metabolic disorders and their impact on cardiac function. This form of cardiomyopathy usually develops in the context of metabolic syndromes such as type 2 diabetes mellitus, obesity, atherosclerosis, and hypertension. Here are the main aspects of the pathogenesis of dysmetabolic cardiomyopathy:

1. Insulinresistance: Insulin resistance is a condition in which the body's cells become less sensitive to the action of insulin. This can occur due to obesity and other metabolic disorders. In response to insulin resistance, the pancreas begins to produce more insulin to compensate. This excess insulin can have negative effects on the heart and blood vessels.
2. Hyperglycemia: High blood sugar levels characteristic of diabetes mellitus can cause damage to the walls of blood vessels, including the coronary arteries, which impairs blood supply to the heart.
3. Obesity: Obesity can contribute to insulin resistance, atherosclerosis and high blood pressure. This increases the strain on the heart and can lead to heart deterioration.
4. Atherosclerosis: Atherosclerosis is the formation of fatty plaques inside the arteries, which can lead to narrowing or blockage of blood vessels. This makes blood flow to the heart more difficult and increases the risk of coronary complications.
5. Hypertension: High blood pressure puts additional strain on the heart and blood vessels, which can lead to deterioration of heart function.
6. Inflammation and Fibrosis: In some cases, metabolic disorders can contribute to inflammation and fibrosis in the heart muscle, impairing its function.

The pathogenesis of dysmetabolic cardiomyopathy is often complex and multifaceted, and involves the interaction of various metabolic risk factors.

Symptoms of the dysmetabolic cardiomyopathy

Symptoms of dysmetabolic cardiomyopathy can be varied and may include the following manifestations:

1. Shortness of breath: The heart's ability to pump blood efficiently can be impaired, resulting in shortness of breath even with little exercise.
2. Fatigue: Patients with dysmetabolic cardiomyopathy often experience feelings of weakness and fatigue due to the heart's reduced ability to maintain normal blood flow.
3. Swelling: Congestive heart failure, which can result from dysmetabolic cardiomyopathy, can cause swelling of the legs, ankles, and even the abdomen.
4. Angina: Lack of oxygen caused by dysmetabolic cardiomyopathy can lead to chest pain or discomfort, especially with exercise.
5. Rapid heartbeats (tachycardia): To compensate for insufficiency, the heart may speed up its contractions, which may cause patients to feel a fast heartbeat.
6. Loss of consciousness: In some cases, especially with abnormal heart rhythm, dysmetabolic cardiomyopathy can cause fainting or loss of consciousness.
7. Increased urine production: Heart dysfunction can lead to increased urine volume (polyuria) and nocturnal urination (nocturia).
8. Weight loss or weight gain: Changes in metabolism can affect body weight, and patients may gain or lose weight.

Diagnostics of the dysmetabolic cardiomyopathy

The following are the main methods for diagnosing dysmetabolic cardiomyopathy:

1. Physical Exam: The physician will perform a physical examination of the patient, including evaluation of symptoms, medical history and risk factors such as diabetes, obesity and dyslipidemia.
2. Electrocardiography (ECG): An ECG is a test that records the electrical activity of the heart. It can show abnormalities in heart rhythm and signs of heart dysfunction.
3. Echocardiography: Echocardiography uses ultrasound waves to create images of the heart. It can show enlargement of the heart's ventricles, decreased contractile function of the heart, and other changes.
4. Magnetic resonance imaging (MRI) of the heart: MRI can provide more detailed images of the structure of the heart and allow assessment of its function.
5. Biochemical blood tests: Laboratory tests may include measuring levels of markers of heart muscle damage, such as troponins, and assessing levels of lipids, glucose, and other metabolism-related substances.
6. Cardiac catheterization: In some cases, cardiac catheterization with angiography may be required to evaluate the coronary arteries and heart pressure in more detail.
7. Cardiac biopsy: Rarely, a biopsy of the heart muscle may be needed to determine the cause of dysmetabolic cardiomyopathy.
8. Risk factor assessment: An important part of the diagnosis of dysmetabolic cardiomyopathy is the assessment of risk factors such as the presence of diabetes mellitus, hypertension, obesity, and dyslipidemia that may contribute to the development of this condition.

Differential diagnosis

The differential diagnosis of dysmetabolic cardiomyopathy involves identifying and distinguishing this condition from other types of cardiomyopathies and heart diseases that may have similar symptoms or characteristics. Below are some conditions and diseases that may be included in the differential diagnosis of dysmetabolic cardiomyopathy:

1. Coronarycardiomyopathy: Coronary cardiomyopathy is caused by impaired blood supply to the heart due to atherosclerosis of the coronary arteries. It may also lead to impaired contractile function of the heart, which is similar to dysmetabolic cardiomyopathy.
2. Hypertrophic cardiomyopathy: Hypertrophic cardiomyopathy is characterized by thickening of the walls of the left ventricle of the heart and can lead to symptoms similar to dysmetabolic cardiomyopathy.
3. Acute myocarditis: Myocarditis is an inflammation of the heart muscle that can be caused by infection or other causes. Symptoms may be similar to dysmetabolic cardiomyopathy.
4. Cardiac amyloidosis: Amyloidosis is a rare disease in which amyloid proteins form in the heart tissue. This can lead to impaired heart function and symptoms that may resemble dysmetabolic cardiomyopathy.
5. Thyrotoxicosis: Hyperfunction of the thyroid gland causing thyroid hormone levels can cause changes in heart rhythm and function that may converge with symptoms of dysmetabolic cardiomyopathy.

To make a differential diagnosis of dysmetabolic cardiomyopathy, the doctor performs a number of tests, including an electrocardiogram (ECG), echocardiography, blood tests to determine glucose levels, cholesterol levels, and other metabolic parameters, as well as a physical examination and review of the patient's medical history.

Treatment of the dysmetabolic cardiomyopathy

Treatment of dysmetabolic cardiomyopathy should be comprehensive and aimed at managing metabolic abnormalities and maintaining and restoring cardiac function. Here are the main aspects of treatment:

1. Diabetes management: If a patient has type 2 diabetes, blood glucose control plays a key role in the management of dysmetabolic cardiomyopathy. This includes taking antiglycemic medications, insulin, and following a carbohydrate-restricted diet.
2. Blood pressure control: Treatment of hypertension (high blood pressure) is important to reduce the strain on the heart. Antihypertensive drugs are prescribed and patients are advised to monitor their blood pressure levels and adjust treatment if necessary.
3. Weight loss: If the patient is overweight or obese, weight loss may improve control of metabolic disorders and reduce the workload on the heart. A guided diet and physical activity plan is recommended.
4. Healthy Eating: Following a healthy diet that limits fat, salt and sugar can help control metabolic risk factors and keep your heart healthy.
5. Physical activity: Regular physical activity under a doctor's supervision can improve overall health, strengthen the heart and blood vessels, and promote weight loss.
6. Drug therapy: Depending on the specific metabolic abnormalities and the patient's heart condition, various medications such as cholesterol-lowering drugs, antihyperglycemic drugs, antihypertensive drugs, and others may be prescribed.
7. Monitoring and regular check-ups: Patients with dysmetabolic cardiomyopathy are recommended to regularly monitor their condition, perform blood tests, electrocardiograms and other examinations to track the dynamics and effectiveness of treatment.
8. Smoking cessation and moderate alcohol use: Smoking cessation and moderate alcohol use can also help reduce the risk of heart complications.

Treatment should be individualized and developed by a physician based on each patient's specific needs and condition.

Forecast

The prognosis of dysmetabolic cardiomyopathy depends on multiple factors, including the severity of the underlying metabolic disorder (e.g., diabetes mellitus, obesity), the extent of heart muscle damage, and the effectiveness of treatment and patient compliance with lifestyle modification recommendations. Important factors affecting prognosis include:

1. Control of the underlying metabolic disorder: Good control of diabetes mellitus and blood pressure management, if they are major risk factors, can improve prognosis and delay the development of dysmetabolic cardiomyopathy.
2. Heart function: The degree of heart muscle damage and deterioration in heart muscle function has a significant impact on prognosis. The higher the contractile function of the heart (usually measured in percentages called ejection fraction), the more serious the prognosis may be.
3. Effective treatment: Current treatments, including drug therapy, diet, exercise, and, in some cases, surgery, can help manage dysmetabolic cardiomyopathy and improve prognosis.
4. Adherence to recommendations: It is important that patients follow their physician's recommendations for controlling metabolic risk factors, taking medications, and making lifestyle changes. Failure to follow recommendations may adversely affect prognosis.
5. Comorbidities: The presence of other medical conditions and complications, such as kidney disease or cardiovascular disorders, may also affect prognosis.

The prognosis of dysmetabolic cardiomyopathy can vary from patient to patient. It is important to see a physician regularly to monitor the condition and receive advice on treatment and management of the disease. With proper management and appropriate medical measures, the prognosis can be improved and the risk of complications can be reduced.

Literature used

• Shlyakhto, E. V. Cardiology: national guide / ed. By E. V. Shlyakhto. - 2nd ed., revision and supplement. - Moscow: GEOTAR-Media, 2021
• Cardiology according to Hurst. Volumes 1, 2, 3. 2023