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Hypertrophy and Cardiomyopathy in the Neuromuscular Diseases

A review of the clinical and experimental settings in which skeletal muscle hypertrophy occurs suggests that where muscle fiber bulk is increased above normal, an increased work load or stretch has been imposed on the muscle. The increased bulk commonly seen in dystrophic and occasionally in neuropathic disorders is mainly due to an increase in connective tissue. Hormonal influences are important for muscle growth, but are not a prerequisite for work hypertrophy. Clinically significant skeletal muscle hypertrophy is rarely, if ever, produced by hormonal excess. Careful assessment of patients with most types of neuromuscular disease has indicated a high frequency of cardiac involvement, suggesting a common etiological factor. In some patients cardiac disease may antedate skeletal muscle involvement. For example, prospective study of 25 patients with myotonic dystrophy yielded evidence for cardiac disease in 7 patients before neuromuscular disease was clinically apparent.