Tachycardia induced cardiomyopathy: Difference between revisions
| Line 22: | Line 22: | ||
*[[Renin]] | *[[Renin]] | ||
*[[Aldosterone]] | *[[Aldosterone]] | ||
Although the precise mechanism is not known, it has been speculated that the underlying mechanism of disease involves a depletion of myocardial energetics<ref>Shinabane JS, Wood MA, Jensen DN, | |||
Ellenbogen KA, Fitzpatrick AP, Scheinman MM. Tachycardia-induced cardiomyopathy: a review of animal models and clinical studies. J Am Coll Cardiol 1997; 29:709-15.</ref>. | |||
==Risk Factors== | ==Risk Factors== | ||
Revision as of 17:55, 16 October 2011
|
Cardiomyopathy Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Guidelines |
|
2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy |
|
Case Studies |
|
Tachycardia induced cardiomyopathy On the Web |
|
American Roentgen Ray Society Images of Tachycardia induced cardiomyopathy |
|
Risk calculators and risk factors for Tachycardia induced cardiomyopathy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and Keywords: chronotropic cardiomyopathy, tachycardiomyopathy
Overview
Tachycardia induced cardiomyopathy is a decline in left ventricular function and left ventricular dilation as a result of chronic or frequently recurring paroxysmal tachycardia. The tachycardia can either be an atrial tachycardia or a ventricular tachycarrhythmia. Depending upon the duration of the tachycardia, the condition is either completely or partially reversible.
Historical Perspective
The relationship between tachycardia and a reversible decline in left ventricular dysfunction was first described by Phillips and Levine in 1949 [1].
Pathophysiology
Animal models demonstrate that sustained atrial or ventricular pacing results in dilation of all four cardiac chambers with thinning of the left and right ventricular walls. Both diastolic and systolic dysfunction develops in all four chambers as well [2]. The left ventricular wall thins, the cardiac output drops and the systemic vascular resistance (SVR)rises. later in the course of the disease, mitral regurgiation may develop due to dilation of the mitral valve anulus.
As a result of the reduced cardiac output, there is activation of the neurohormonal axis with elevations of the following hormones:
Although the precise mechanism is not known, it has been speculated that the underlying mechanism of disease involves a depletion of myocardial energetics[3].
Risk Factors
The rate and duration of the elevation in heart rate necessary to cause a cardiomyopathy is unclear and is likely dependent on a number of unknown factors.
Prognosis
Depending upon the duration of the tachycardia, the condition is either completely or partially reversible after some time.[4] The pace of recovery of left ventricual dysfunctionis similar to that of hibernating myocardium [5]. It may take one year for instance for left ventricular function to recover [6][7]
Treatment
The primary treatment for a tachycardia induced cardiomyopathy is correct the underlying tachycardia. This may include the use of:
- Negative chronotropic agents such as beta blockers
- Cardioversion
- AV node ablation
- Treatment of the underlying condition such as hyperthyroidism or atrial fibriallation
Supportive agents such as ACE inhibitors / angiotensin receptor blockers are of benefit to try to prevent remodeling of the left ventricle.
References
- ↑ Phillips E, Levine SA. Auricular fibrillation without other evidence of heart disease: a cause of reversible heart failure. Am J Med 1949; 7:478-89.
- ↑ Whipple GH, Sheffield LT, Woodman EG. Reversible congestive heart failure due to chronic rapid stimulation of the normal heart. Pro N Engl Cardiovasc Soc 1962; 20:39-40.
- ↑ Shinabane JS, Wood MA, Jensen DN, Ellenbogen KA, Fitzpatrick AP, Scheinman MM. Tachycardia-induced cardiomyopathy: a review of animal models and clinical studies. J Am Coll Cardiol 1997; 29:709-15.
- ↑ Calo L, Sciarra L, Scioli R, Lamberti F, Loricchio ML, Pandozi C, Santini M. (2005). "Recovery of cardiac function after ablation of atrial tachycardia arising from the tricuspid annulus". Ital Heart J. 6 (8): 652–7. PMID 16161499.
- ↑ Rahimatoola SH. From coronary artery disease to heart failure: role of the hibernating myocardium. Am J Cardiol 1995; 75:16-22E.
- ↑ Fenelon G,Wijns W,Andries E, Brugada P. Tachycardiomyopathy: mechanisms and clinical applications. Pacing Clin Electrophysiol 1996; 19:95-106.
- ↑ Kessler G, Rosenblatt S, Friedman J, Kaplinsky E. Recurrent dilated cardiomyopathy reversed with conversion of atrial fibrillation. Am Heart J 1997; 133:384-6.