Ischemic cardiomyopathy

Ischemic cardiomyopathy has a significant impact on cardiovascular health. It is the leading cause of about 60 % of systolic heart failure cases worldwide and is linked to a much higher mortality rate than non-ischemic cardiomyopathy. The most common cause of ischemic cardiomyopathy is atherosclerosis of the large coronary arteries; about six million people in the USA have heart failure related to coronary atherosclerosis. Diagnosis of ischemic cardiomyopathy is straightforward in patients with extensive prior myocardial infarction and stenosis of all three coronary arteries or the left main coronary. This chapter explores key aspects of this condition, starting with the "mechanics"-how it affects blood flow, blood oxygen-carrying capacity, and vessel tone and caliber-and the role of imaging in making a diagnosis and identifying blood flow and ventricular and valvular function. Potential complications are described, including infarction-related aneurysm, embolism, and mitral regurgitation. Medical therapy for ischemic cardiomyopathy is similar to that for heart failure except for additional treatment to prevent further myocardial ischemia and infarction. Benefits of cardiac rhythm therapy are discussed, as are surgical treatment options, ranging from revascularization to left ventricular volume reduction. Ischemic cardiomyopathy (IschCM) refers to myocardial dysfunction that results from myocardial ischemia. Myocardial ischemia is usually related to insufficient delivery of blood flow through the coronary circulation to the cardiomyocyte. Ischemia results not only in reduced systolic pump function through myocyte ischemia but also leads to increased ventricular diastolic stiffness (often called diastolic heart failure) and loss of cardiac myocytes altogether (infarction).