SymposiumObesity Cardiomyopathy: Pathophysiology and Evolution of the Clinical Syndrome
Section snippets
Fatty Infiltration of the Heart
Fatty infiltration of the heart is characterized by extension of epicardial fat into ventricular and atrial myocardium.6., 9. It most commonly affects the right ventricle, perivascular regions and cardiac skeleton.6., 7., 8., 9. From ancient times through the early years of this century it was presumed that cardiac dysfunction associated with obesity resulted from fatty infiltration of myocardium.6 In 1933, Smith and Willius7 reported excessive epicardial fat to be present in 95% of 135
Post-Mortem and Endomyocardial Biopsy Studies
In 1933, Smith and Willius7 reported postmortem findings in 135 patients who were 102 to 150 kg (13–170% overweight), including 4 morbidly obese subjects who died of congestive heart failure. Most had underlying cardiovascular disease, usually hypertension or coronary artery disease. Heart weight paralleled increasing body weight up to 105 kg. Thereafter, heart weight increased less in relation to body weight. Heart weights for men and women (444 and 345 g, respectively) were substantially higher
Central Hemodynamics
An early study of 40 morbidly obese subjects by Alexander et al36 demonstrated a linear positive correlation between the amount overweight and both blood volume and cardiac output. In this study, heart rate in obese patients did not differ from that in lean subjects and was not higher with more severe obesity. However, stroke volume increased in proportion to the excess in body weight and cardiac work increased over that predicted for ideal body weight because of increased stroke work. In a
Left Ventricular Diastolic Function
The presence of eccentric left ventricular hypertrophy, often present in morbidly obese persons, would be expected to predispose to left ventricular diastolic dysfunction. In his 1964 study38 of obesity and cardiac performance, Alexander confirmed that pulmonary vascular congestion was commonly present in extremely obese patients. This study of 40 moderately to severely obese subjects showed normal pulmonary artery pressure at rest and with exercise in 25%, elevated pulmonary artery pressure at
Symptoms and Signs
Symptoms and signs of obesity cardiomyopathy occur most often in patients whose actual body weight is ≥ 75% over ideal body weight or whose body mass index is ≥ 40 kg/m2.66., 67., 68., 69., 70., 71., 72., 73., 74. The clinical syndrome of obesity cardiomyopathy occurs in approximately 10% of such persons and typically in those with a duration of obesity ≥ 10 years.66., 67., 68., 69., 70., 71., 72., 73., 74.
In the early stages, recent weight gain precedes and then accompanies progressive dyspnea on
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Historical notes
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