Cardiomyopathies - emergency medicine perspective
Cardiomyopathies are a heterogeneous group of diseases of the myocardium that produce structural or electrical dysfunction. They commonly present to the ED with acute heart failure, arrhythmia, syncope, device problems, chest pain with troponin rise, or cardiogenic shock.
Emergency management focuses on rapid recognition of haemodynamic or electrical instability, organ support, condition‑specific stabilisation and early liaison with cardiology, heart‑failure teams or critical care for escalation (including consideration of mechanical circulatory support).
Pragmatic classification for ED use
Group cardiomyopathies by the way they present and the ED implications rather than exhaustive aetiology.
- Primary (genetic or primary myocardial disease): hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), left ventricular non‑compaction (LVNC), ion‑channelopathies, familial dilated cardiomyopathy.
- Mixed/primary acquired: dilated cardiomyopathy (DCM), restrictive cardiomyopathy, myocarditis, takotsubo cardiomyopathy, peripartum cardiomyopathy, tachycardia‑induced cardiomyopathy.
- Secondary (systemic/infiltrative/toxic/metabolic): cardiac amyloidosis (ATTR/AL), haemochromatosis, storage disorders, chemotherapy- or toxin‑related cardiomyopathy, endocrine, nutritional and neuromuscular causes.
Common ED‑relevant phenotypes and implications
- HCM - dynamic left ventricular outflow tract (LVOT) obstruction: presents with syncope or exertional collapse; avoid preload reduction and inotropes if obstruction suspected.
- DCM - systolic dysfunction and congestion: typically responds to diuresis; risk of cardiogenic shock and malignant arrhythmia.