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Assessment/Diagnosis
Obesity-Related Cardiomyopathy
➤ Obesity-related cardiomyopathy is more prevalent in individuals
with BMI ≥35 kg/m², stems from visceral adiposity-driven
hemodynamic overload, neurohormonal remodeling, and
metabolic injury, including lipotoxicity and myocardial fibrosis,
and accounts for 5% to 10% of HF cases, particularly in younger
men and those with coexisting sleep apnea.
➤ Signs and Symptoms
• Early manifestations include exercise intolerance, fatigue, and
exertional dyspnea, symptoms that may be overlooked due to
decreased physical activity. As the disease progresses, patients may
develop peripheral edema, orthopnea, and features of high-output
HF. Clinical signs such as elevated jugular venous pressure can be
masked by neck adiposity. Additionally, individuals are at increased
risk for arrhythmias, notably atrial f ibrillation, which increases by
3% to 8% per BMI unit, and sudden cardiac death resulting f rom
ventricular hypertrophy or f ibrosis.
Arrhythmias
➤ Obesity increases the likelihood of arrhythmias, particularly
atrial fibrillation, due to structural cardiac changes, autonomic
dysfunction, and sleep-disordered breathing. Symptoms include
palpitations, chest discomfort, dyspnea, syncope, or presyncope.
Prompt cardiology referral is appropriate for suspected HF or
arrhythmias to facilitate appropriate diagnostic evaluation and
management.
