Skip to main content

Cardiovascular Manifestations of Myotonic Dystrophy

  • Chapter
  • First Online:
Cardiovascular Genetics and Genomics

Abstract

The myotonic dystrophies type 1 and type 2 are the most frequently inherited neuromuscular diseases of adult life. They are progressive multisystem disorders and predominantly affect the conduction system of the heart. Tachy and bradyarrhythmias are the predominant cardiac manifestation and are associated with up to 30% of all cause mortality in DM. Routine cardiac screening is recommended in all patients with a minimum of a yearly ECG, ECHO and 24 h Holter monitoring. In our practice we recommend electrophysiological studies when there are any abnormalities on the ECG. Future work will aim to define criteria for implantation of pacemakers and implantable cardioverter defibrillators.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 329.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Harper PS. Myotonic dystrophy. 3rd ed. Philadelphia: W.B. Saunders; 2001.

    Google Scholar 

  2. Brook JD, McCurrach ME, Harley HG, Buckler AJ, Church D, Aburatani H, Hunter K, Stanton VP, Thirion JP, Hudson T. Molecular basis of myotonic dystrophy: expansion of a trinucleotide (CTG) repeat at the 3′ end of a transcript encoding a protein kinase family member. Cell. 1992;69(2):385.

    Article  CAS  PubMed  Google Scholar 

  3. Hamshere MG, Harley H, Harper P, Brook JD, Brookfield JF. Myotonic dystrophy: the correlation of (CTG) repeat length in leucocytes with age at onset is significant only for patients with small expansions. J Med Genet. 1999;36(1):59–61.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Lavedan C, Hofmann-Radvanyi H, Shelbourne P, Rabes JP, Duros C, Savoy D, Dehaupas I, Luce S, Johnson K, Junien C. Myotonic dystrophy: size- and sex-dependent dynamics of CTG meiotic instability, and somatic mosaicism. Am J Hum Genet. 1993;52(5):875–83.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Morales F, Couto JM, Higham CF, Hogg G, Cuenca P, Braida C, Wilson RH, et al. Somatic instability of the expanded CTG triplet repeat in myotonic dystrophy type 1 is a heritable quantitative trait and modifier of disease severity. Hum Mol Genet. 2012;21(16):3558–67. https://doi.org/10.1093/hmg/dds185.

    Article  CAS  PubMed  Google Scholar 

  6. Liquori CL, Ricker K, Moseley ML, Jacobsen JF, Kress W, Naylor SL, Day JW, Ranum LP. Myotonic dystrophy type 2 caused by a CCTG expansion in intron 1 of ZNF9. Science. 2001;293(5531):864–7. https://doi.org/10.1126/science.1062125.

    Article  CAS  PubMed  Google Scholar 

  7. Day JW, Ricker K, Jacobsen JF, Rasmussen LJ, Dick KA, Kress W, Schneider C, et al. Myotonic dystrophy type 2: molecular, diagnostic and clinical spectrum. Neurology. 2003;60(4):657–64.

    Article  CAS  PubMed  Google Scholar 

  8. Mathieu J, Allard P, Potvin L, Prévost C, Bégin P. A 10-year study of mortality in a cohort of patients with myotonic dystrophy. Neurology. 1999;52(8):1658–62.

    Article  CAS  PubMed  Google Scholar 

  9. Wahbi K, Meune C, Bécane HM, Laforêt P, Bassez G, Lazarus A, Radvanyi-Hoffman H, Eymard B, Duboc D. Left ventricular dysfunction and cardiac arrhythmias are frequent in type 2 myotonic dystrophy: a case control study. Neuromuscul Disord. 2009;19(7):468–72. https://doi.org/10.1016/j.nmd.2009.04.012.

    Article  PubMed  Google Scholar 

  10. Groh WJ, Groh MR, Saha C, Kincaid JC, Simmons Z, Ciafaloni E, Pourmand R, et al. Electrocardiographic abnormalities and sudden death in myotonic dystrophy type 1. N Engl J Med. 2008;358(25):2688–97. https://doi.org/10.1056/NEJMoa062800.

    Article  CAS  PubMed  Google Scholar 

  11. Kennel AJ, Titus JL, Merideth J. Pathologic findings in the atrioventricular conduction system in myotonic dystrophy. Mayo Clin Proc. 1974;49(11):838–42.

    CAS  PubMed  Google Scholar 

  12. Lazarus A, Varin J, Ounnoughene Z, Radvanyi H, Junien C, Coste J, Laforet P, et al. Relationships among electrophysiological findings and clinical status, heart function, and extent of DNA mutation in myotonic dystrophy. Circulation. 1999;99(8):1041–6.

    Article  CAS  PubMed  Google Scholar 

  13. Groh WJ, Lowe MR, Zipes DP. Severity of cardiac conduction involvement and arrhythmias in myotonic dystrophy type 1 correlates with age and CTG repeat length. J Cardiovasc Electrophysiol. 2002;13(5):444–8.

    Article  PubMed  Google Scholar 

  14. Melacini P, Villanova C, Menegazzo E, Novelli G, Danieli G, Rizzoli G, Fasoli G, Angelini C, Buja G, Miorelli M. Correlation between cardiac involvement and CTG trinucleotide repeat length in myotonic dystrophy. J Am Coll Cardiol. 1995;25(1):239–45.

    Article  CAS  PubMed  Google Scholar 

  15. Babuty D, Fauchier L, Tena-Carbi D, Poret P, Leche J, Raynaud M, Fauchier JP, Cosnay P. Is it possible to identify Infrahissian cardiac conduction abnormalities in myotonic dystrophy by non-invasive methods? Heart. 1999;82(5):634–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. McNally EM, Sparano D. Mechanisms and management of the heart in myotonic dystrophy. Heart. 2011;97(13):1094–100. https://doi.org/10.1136/hrt.2010.214197.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Nguyen HH, Wolfe JT, Holmes DR, Edwards WD. Pathology of the cardiac conduction system in myotonic dystrophy: a study of 12 cases. J Am Coll Cardiol. 1988;11(3):662–71.

    Article  CAS  PubMed  Google Scholar 

  18. Merino JL, Carmona JR, Fernández-Lozano I, Peinado R, Basterra N, Sobrino JA. Mechanisms of sustained ventricular tachycardia in myotonic dystrophy: implications for catheter ablation. Circulation. 1998;98(6):541–6.

    Article  CAS  PubMed  Google Scholar 

  19. Pelargonio G, Dello Russo A, Sanna T, De Martino G, Bellocci F. Myotonic dystrophy and the heart. Heart. 2002;88(6):665–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Bhakta D, Lowe MR, Groh WJ. Prevalence of structural cardiac abnormalities in patients with myotonic dystrophy type I. Am Heart J. 2004;147(2):224–7. https://doi.org/10.1016/j.ahj.2003.08.008.

    Article  PubMed  Google Scholar 

  21. Bhakta D, Groh MR, Shen C, Pascuzzi RM, Groh WJ. Increased mortality with left ventricular systolic dysfunction and heart failure in adults with myotonic dystrophy type 1. Am Heart J. 2010;160(6):1137–1141., 1141.e1. https://doi.org/10.1016/j.ahj.2010.07.032.

    Article  PubMed  Google Scholar 

  22. Fragola PV, Caló L, Luzi M, Mammarella A, Antonini G. Doppler echocardiographic assessment of left ventricular diastolic function in myotonic dystrophy. Cardiology. 1997;88(6):498–502.

    Article  CAS  PubMed  Google Scholar 

  23. Itoh H, Shimizu M, Horita Y, Ino H, Taguchi T, Kajinami K, Yagi K, Chujo D, Mabuchi H. Microvascular ischemia in patients with myotonic dystrophy. Jpn Circ J. 2000;64(9):720–2.

    Article  CAS  PubMed  Google Scholar 

  24. Phillips MF, Harper PS. Cardiac disease in myotonic dystrophy. Cardiovasc Res. 1997;33(1):13–22.

    Article  CAS  PubMed  Google Scholar 

  25. Sovari AA, Bodine CK, Farokhi F. Cardiovascular manifestations of myotonic dystrophy-1. Cardiol Rev. 2007;15(4):191–4. https://doi.org/10.1097/CRD.0b013e318070d1a7.

    Article  PubMed  Google Scholar 

  26. Wahbi K, Meune C, Porcher R, Bécane HM, Lazarus A, Laforêt P, Stojkovic T, et al. Electrophysiological study with prophylactic pacing and survival in adults with myotonic dystrophy and conduction system disease. JAMA. 2012;307(12):1292–301. https://doi.org/10.1001/jama.2012.346.

    Article  CAS  PubMed  Google Scholar 

  27. Hermans MCE, Faber CG, Bekkers SCAM, de Die-Smulders CEM, Gerrits MM, Merkies ISJ, Snoep G, Pinto YM, Schalla S. Structural and functional cardiac changes in myotonic dystrophy type 1: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson. 2012;14:48. https://doi.org/10.1186/1532-429X-14-48.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Bassez G, Lazarus A, Desguerre I, Varin J, Laforêt P, Bécane HM, Meune C, et al. Severe cardiac arrhythmias in young patients with myotonic dystrophy type 1. Neurology. 2004;63(10):1939–41.

    Article  CAS  PubMed  Google Scholar 

  29. Muraoka H, Negoro N, Terasaki F, Nakakoji T, Kojima S, Hoshiga M, Sugino M, Hosokawa T, Ishihara T, Hanafusa T. Re-entry circuit in ventricular tachycardia due to focal fatty-fibrosis in a patient with myotonic dystrophy. Intern Med. 2005;44(2):129–35.

    Article  PubMed  Google Scholar 

  30. Kilic T, Vural A, Ural D, Sahin T, Agacdiken A, Ertas G, Yildiz Y, Komsuoglu B. Cardiac resynchronization therapy in a case of myotonic dystrophy (Steinert’s disease) and dilated cardiomyopathy. Pacing Clin Electrophysiol. 2007;30(7):916–20. https://doi.org/10.1111/j.1540-8159.2007.00782.x.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Chris Turner .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Vivekananda, U., Hanna, M., Turner, C. (2018). Cardiovascular Manifestations of Myotonic Dystrophy. In: Kumar, D., Elliott, P. (eds) Cardiovascular Genetics and Genomics. Springer, Cham. https://doi.org/10.1007/978-3-319-66114-8_18

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-66114-8_18

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-66112-4

  • Online ISBN: 978-3-319-66114-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics