Q. Explain Clinical Manifestations of cardiomyopathy?

1) Asymptomatic, when the diagnosis is made by 2D Echocardiography.

2) Enlargement of LV. Apex is shifted down and out. The apex impulse is not forceful. Presystolic gallop (S4) may precede the development of failure. Ventricular gallop (S3) is common during decompensation. Regurgitant murmurs are common. Mitral regurgitation is due to enlargement and abnormal motion of mitral annulus and distortion of the geometry of subvalvar apparatus. Ventricular dilatation plays a lesser role. 2nd sound may show reverse split, if LBBB occurs. They present with symptoms and signs of heart failare, as follows:

a) Pulmonary Congestion

Dyspnoea on exertion or at rest, paroxysmal nocturnal dyspnoea. Tachypnoea, pulmonary rales, bronchial spasm and occasional rhonci.

b) Systemic Congestion

Distended neck veins, palpable tender liver and edema of legs and at times ascites, and pleural effusion.

c) Fall in Cardiac Output and Poor Peripheral Perfusion

Fatigue, weakness, Narrowing of pulse pressure, hypotension, Cold and pale extremities with constricted peripheral veins and delayed capillary refill.

d) Arrhythmias

Palpitations, light headedness, syncope etc.