Hospital therapy. Differential diagnosis, treatment and prevention of restrictive cardiomyopathy (RCMP) (most important)

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Hospital therapy. Differential diagnosis, treatment and prevention of restrictive cardiomyopathy (RCMP) (most important)

Lecture notes, cheat sheets

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16. Differential diagnosis, treatment and prevention of restrictive cardiomyopathy (RCMP)

Differential diagnosis. In the differential diagnosis of RCMP, it is very important to take into account the similarity of the disease in external manifestations with constrictive pericarditis, but the treatment method for these diseases is diametrically opposed. Live biopsy of the myocardium and endocardium is usually used simultaneously with cardiac probing, which allows you to have more information to clarify the nature of the disease and further treatment. In extremely rare cases, when the above diagnostic methods do not allow distinguishing RCMP from constrictive pericarditis, a direct revision of the pericardium is performed on the operating table.

All patients with RCMP need a comprehensive clinical, biochemical and additional examination to determine non-cardiac causes of the disease.

Treatment. Treatment of the disease presents significant difficulties. Most drugs that are used to treat heart failure may not bring the desired results due to the fact that, due to the characteristics of the disease, it is impossible to obtain a significant improvement in myocardial compliance (in some cases, calcium ion antagonists are prescribed for this purpose). Diuretics (aldactone) are used to eliminate excess fluid in the body. To eliminate persistent conduction disorders, it may be necessary to set up (implant) a permanent pacemaker.

This is caused by diseases such as sarcoidosis and hemochromatosis, leading to the development of secondary RCMP, they are subject to self-treatment. In the treatment of sarcoidosis, hormonal drugs (prednisolone, etc.) are used, and in hemochromatosis, regular bloodletting (to reduce the concentration of iron in the body). Treatment of myocardial amyloidosis is directly dependent on the causes of its occurrence. It is advisable to use anticoagulant drugs for thrombosis in the chambers of the heart.

Surgical treatment is resorted to in cases of RCMP caused by endocardial damage. During the operation, if possible, the part of the endocardium that has undergone changes is excised. In some cases, if there is insufficiency of the atrioventricular valves, their prosthesis is performed. Some forms of amyloid myocardial damage are treated with a heart transplant.

Prevention of RCM. Unfortunately, preventive measures for this disease are limited. Most importantly, early detection of potentially removable causes of amyloidosis, sarcoidosis, hemochromatosis, etc. is necessary. To achieve these goals, it is of great importance to conduct an annual medical examination of the population.

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