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matory reaction as well as a chronic fibrosis of heart muscle, usually in conjunction with pericarditis The incidence of cocaine cardiotoxicity has increased markedly Cocaine can cause coronary artery spasm, myocardial infarction, arrhythmias, and myocarditis Because many of these processes are believed to be mediated by cocaine s inhibitory effect on norepinephrine reuptake by sympathetic nerves, -blockers have been used therapeutically In documented coronary spasm, calcium channel blockers and nitrates may be effective

Floyd JD et al Cardiotoxicity of cancer therapy J Clin Oncol 2005 Oct 20;23(30):7685 96 [PMID: 16234530] Gharib MI et al Chemotherapy-induced cardiotoxicity: current practice and prospects of prophylaxis Eur J Heart Fail 2002 Jun;4(3):235 42 [PMID: 12034146] Yeh ET et al Cardiovascular complications of cancer therapy: diagnosis, pathogenesis, and management Circulation 2004 Jun 29;109(25):3122 31 [PMID: 15226229]

Symptoms and signs of heart failure Examination often reveals cardiomegaly, elevated JVP, S3, S4, mitral and tricuspid regurgitation, low systemic BP and pulse width, occasionally pulsus alternans ECG may show low QRS voltage, nonspecific repolarization abnormalities, intraventricular conduction abnormalities Radiograph shows cardiomegaly Echocardiogram confirms LV dilation, thinning, and global dysfunction

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The cardiomyopathies are a heterogeneous group of entities affecting the myocardium primarily and not associated with the major causes of cardiac disease, ie, ischemic heart disease, hypertension, pericardial disease, valvular disease, or congenital defects Recently, two additional entities have been added to the list: a transient cardiomyopathy due to high catecholamine discharge (Tako-Tsubo cardiomyopathy) and an embryologic defect resulting in massive trabeculation in the LV (ventricular noncompaction) Although some have specific causes, many cases are idiopathic The classification of cardiomyopathies is based on features of presentation and pathophysiology (Table 10 12) Dilated cardiomyopathies cause about 25% of all cases of CHF It usually presents with symptoms and signs of CHF (most commonly dyspnea) Occasionally, symptomatic ventricular arrhythmias are the presenting event LV dilation and systolic dysfunction (EF < 50%) are essential for diagnosis Dilated cardiomyopathy occurs more often in blacks than whites and in men more than women A growing number of cardiomyopathies due to genetic

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