Cardiomyopathy, referring to pathology of the heart muscle, can be categorized as primary cardiomyopathies and secondary cardiomyopathies. Primary cardiomyopathy includes genetic or acquired primary heart disorders, while secondary cardiomyopathy is due to some external factor. Regardless of etiology, patterns of cardiomyopathy can be classified as restrictive, dilated, or hypertrophic. The most common primary cardiomyopathy is called hypertrophic cardiomyopathy, which, aside from standard heart failure symptoms, can cause sudden death, usually because of arrhythmia. Dilated cardiomyopathy has many etiologies, both primary and secondary; it is defined by classic heart failure symptoms in association with a reduced ejection fraction. Restrictive cardiomyopathy is quite rare and usually falls into the category of secondary cardiomyopathy resulting from systemic disease. There are also other rare presentations of cardiomyopathy of which clinicians should be aware (e.g., stress-induced or peripartum cardiomyopathies, arrhythmogenic right ventricular dysplasia).
Electrocardiography and echocardiography are necessary complements to a thorough history and physical examination in guiding prognosis and treatment options. Heart failure therapies are guided by clinical stage and involve lifestyle modifications, possible ICD placement, and, if refractory to optimal medical management, heart transplantation.
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