Dilated cardiomyopathy history and symptoms: Difference between revisions
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{{CMG}}; '''Associate Editor-in-Chief:''' Sachin Shah, M.D. | {{CMG}}; '''Associate Editor-in-Chief:''' Sachin Shah, M.D. | ||
==Overview== | ==Overview== | ||
Common symptoms in the setting of dilated cardiomyopathy include [[chest pain]], [[cough]], [[fatigue]], [[loss of appetite]], and [[shortness of breath]]. A careful history is important in the setting of [[dilated cardiomyopathy]] in order to ascertain the etiology of the [[cardiomyopathy]]. The patient needs to be evaluated for a history of [[coronary artery disease]], viral [[prodrome]] and [[Infection|infections]], [[chemotherapy]], [[HIV]] risk factors, [[pregnancy]], [[medication]]s, [[toxin]]s, and [[substance abuse]]. | Common symptoms in the setting of [[dilated cardiomyopathy]] include [[chest pain]], [[cough]], [[fatigue]], [[loss of appetite]], and [[shortness of breath]]. A careful history is important in the setting of [[dilated cardiomyopathy]] in order to ascertain the etiology of the [[cardiomyopathy]]. The patient needs to be evaluated for a history of [[coronary artery disease]], viral [[prodrome]] and [[Infection|infections]], [[chemotherapy]], [[HIV]] risk factors, [[pregnancy]], [[medication]]s, [[toxin]]s, and [[substance abuse]]. | ||
==History and Symptoms== | ==History and Symptoms== | ||
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=== History === | === History === | ||
* In terms of determining the etiology, a careful history is most instrumental. | * In terms of determining the [[etiology]], a careful [[History and Physical examination|history]] is most instrumental.<ref name="pmid20189027">{{cite journal| author=Jefferies JL, Towbin JA| title=Dilated cardiomyopathy. | journal=Lancet | year= 2010 | volume= 375 | issue= 9716 | pages= 752-62 | pmid=20189027 | doi=10.1016/S0140-6736(09)62023-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20189027 }}</ref> | ||
* If the patient has CAD ([[coronary artery disease]]) risk factors, known CAD, or [[angina]] then a workup for CAD should be undertaken with [[coronary angiography]]. | * If the patient has CAD ([[coronary artery disease]]) risk factors, known CAD, or [[angina]] then a workup for CAD should be undertaken with [[coronary angiography]]. | ||
* A viral [[prodrome]] such as viral [[URI]] or viral [[gastroenteritis]] may make viral [[myocarditis]] as a more likely cause. If the patient was exposed to [[chemotherapy]] such as [[anthracyclines]] then this would be the likely cause. | * A viral [[prodrome]] such as viral [[URI]] or viral [[gastroenteritis]] may make viral [[myocarditis]] as a more likely cause. If the patient was exposed to [[chemotherapy]] such as [[anthracyclines]], then this would be the likely cause.<ref name="pmid7969328">{{cite journal| author=Dec GW, Fuster V| title=Idiopathic dilated cardiomyopathy. | journal=N Engl J Med | year= 1994 | volume= 331 | issue= 23 | pages= 1564-75 | pmid=7969328 | doi=10.1056/NEJM199412083312307 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7969328 }}</ref> | ||
* Patients at risk for [[HIV]] should undergo testing as HIV can cause a dilated cardiomyopathy. | * Patients at risk for [[HIV]] should undergo testing as [[Human Immunodeficiency Virus (HIV)|HIV]] can cause a [[dilated cardiomyopathy]]. | ||
* [[Peripartum cardiomyopathy]] most often occurs 1 month prior to expected delivery or 5 months after delivery, so recent childbirth is important information. Often by 8 months gestational age [[pregnancy]] is physically apparent but it is important to rule out [[pregnancy]] in women of childbearing age with dilated cardiomyopathy. | * [[Peripartum cardiomyopathy]] most often occurs 1 month prior to expected delivery or 5 months after delivery, so recent [[childbirth]] is important information. Often by 8 months gestational age [[pregnancy]] is physically apparent, but it is important to rule out [[pregnancy]] in women of childbearing age with [[dilated cardiomyopathy]].<ref name="pmid30700415">{{cite journal| author=Honigberg MC, Givertz MM| title=Peripartum cardiomyopathy. | journal=BMJ | year= 2019 | volume= 364 | issue= | pages= k5287 | pmid=30700415 | doi=10.1136/bmj.k5287 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30700415 }}</ref> | ||
* Screening questions regarding [[cocaine]] or [[alcohol]] abuse or other [[toxin]] exposure (such as [[cobalt]]) should be addressed. | * Screening questions regarding [[cocaine]] or [[alcohol]] abuse or other [[toxin]] exposure (such as [[cobalt]]) should be addressed. | ||
* Symptoms of heart failure are most common. Usually, they develop slowly over time. However, sometimes symptoms start very suddenly and are severe. | * Symptoms of [[Congestive heart failure|heart failure]] are most common. Usually, they develop slowly over time. However, sometimes symptoms start very suddenly and are severe. | ||
=== Common symptoms === | === Common symptoms === | ||
The common symptoms of dilated cardiomyopathy include:<ref name="pmid27339497">{{cite journal| author=Japp AG, Gulati A, Cook SA, Cowie MR, Prasad SK| title=The Diagnosis and Evaluation of Dilated Cardiomyopathy. | journal=J Am Coll Cardiol | year= 2016 | volume= 67 | issue= 25 | pages= 2996-3010 | pmid=27339497 | doi=10.1016/j.jacc.2016.03.590 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27339497 }}</ref> | |||
*[[Chest pain]] or pressure (more likely when you exercise) | *[[Chest pain]] or pressure (more likely when you exercise) | ||
| Line 26: | Line 27: | ||
*[[Loss of appetite]] | *[[Loss of appetite]] | ||
*[[Shortness of breath]] with activity or after lying down (or being asleep) for a while | *[[Shortness of breath]] with activity or after lying down (or being asleep) for a while | ||
*[[Pedal edema]] (in adults | *[[Pedal edema]] (in adults) | ||
The clinical presentation of dilated cardiomyopathy is similar to that [[heart failure]] from any cause. [[Dyspnea]] on exertion, [[orthopnea]], [[paroxysmal nocturnal dyspnea]], lower extremity [[edema]] and [[orthostasis]] / [[syncope]] are all common findings in dilated cardiomyopathy. | The clinical presentation of [[dilated cardiomyopathy]] is similar to that [[heart failure]] from any cause.<ref name="pmid28722940">{{cite journal| author=| title=StatPearls | journal= | year= 2019 | volume= | issue= | pages= | pmid=28722940 | doi= | pmc= | url= }}</ref> | ||
* [[Dyspnea]] on exertion, [[orthopnea]], [[paroxysmal nocturnal dyspnea]], lower extremity [[edema]] and [[orthostasis]] / [[syncope]] are all common findings in dilated cardiomyopathy. | |||
* In addition, dilated cardiomyopathy may present as [[palpitations]] as a result of [[arrhythmia]] (ventricular or atrial) with the most common arrhythmia being [[atrial fibrillation]]. | |||
* Dilated cardiomyopathy may also present as [[sudden cardiac death]] or as CVA ([[cerebrovascular accident]]) or other embolic phenomenon (either from associated [[atrial fibrillation]] or from ventricular thrombi as a result of dilated ventricular cavities). | |||
=== Less Common Symptoms === | === Less Common Symptoms === | ||
[[Angina]] is not a common feature of dilated cardiomyopathy unless the cause is related to [[coronary artery disease]]. If [[angina]] is present | |||
* [[Angina]] is not a common feature of [[dilated cardiomyopathy]] unless the cause is related to [[coronary artery disease]]. | |||
* If [[angina]] is present, work up for [[cardiac ischemia]] should be undertaken.<ref name="pmid27339497" /> | |||
==References== | ==References== | ||
Latest revision as of 17:13, 30 December 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-in-Chief: Sachin Shah, M.D.
Overview
Common symptoms in the setting of dilated cardiomyopathy include chest pain, cough, fatigue, loss of appetite, and shortness of breath. A careful history is important in the setting of dilated cardiomyopathy in order to ascertain the etiology of the cardiomyopathy. The patient needs to be evaluated for a history of coronary artery disease, viral prodrome and infections, chemotherapy, HIV risk factors, pregnancy, medications, toxins, and substance abuse.
History and Symptoms
History
- In terms of determining the etiology, a careful history is most instrumental.[1]
- If the patient has CAD (coronary artery disease) risk factors, known CAD, or angina then a workup for CAD should be undertaken with coronary angiography.
- A viral prodrome such as viral URI or viral gastroenteritis may make viral myocarditis as a more likely cause. If the patient was exposed to chemotherapy such as anthracyclines, then this would be the likely cause.[2]
- Patients at risk for HIV should undergo testing as HIV can cause a dilated cardiomyopathy.
- Peripartum cardiomyopathy most often occurs 1 month prior to expected delivery or 5 months after delivery, so recent childbirth is important information. Often by 8 months gestational age pregnancy is physically apparent, but it is important to rule out pregnancy in women of childbearing age with dilated cardiomyopathy.[3]
- Screening questions regarding cocaine or alcohol abuse or other toxin exposure (such as cobalt) should be addressed.
- Symptoms of heart failure are most common. Usually, they develop slowly over time. However, sometimes symptoms start very suddenly and are severe.
Common symptoms
The common symptoms of dilated cardiomyopathy include:[4]
- Chest pain or pressure (more likely when you exercise)
- Cough
- Fatigue, weakness, faintness
- Irregular or rapid pulse
- Loss of appetite
- Shortness of breath with activity or after lying down (or being asleep) for a while
- Pedal edema (in adults)
The clinical presentation of dilated cardiomyopathy is similar to that heart failure from any cause.[5]
- Dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, lower extremity edema and orthostasis / syncope are all common findings in dilated cardiomyopathy.
- In addition, dilated cardiomyopathy may present as palpitations as a result of arrhythmia (ventricular or atrial) with the most common arrhythmia being atrial fibrillation.
- Dilated cardiomyopathy may also present as sudden cardiac death or as CVA (cerebrovascular accident) or other embolic phenomenon (either from associated atrial fibrillation or from ventricular thrombi as a result of dilated ventricular cavities).
Less Common Symptoms
- Angina is not a common feature of dilated cardiomyopathy unless the cause is related to coronary artery disease.
- If angina is present, work up for cardiac ischemia should be undertaken.[4]
References
- ↑ Jefferies JL, Towbin JA (2010). "Dilated cardiomyopathy". Lancet. 375 (9716): 752–62. doi:10.1016/S0140-6736(09)62023-7. PMID 20189027.
- ↑ Dec GW, Fuster V (1994). "Idiopathic dilated cardiomyopathy". N Engl J Med. 331 (23): 1564–75. doi:10.1056/NEJM199412083312307. PMID 7969328.
- ↑ Honigberg MC, Givertz MM (2019). "Peripartum cardiomyopathy". BMJ. 364: k5287. doi:10.1136/bmj.k5287. PMID 30700415.
- ↑ 4.0 4.1 Japp AG, Gulati A, Cook SA, Cowie MR, Prasad SK (2016). "The Diagnosis and Evaluation of Dilated Cardiomyopathy". J Am Coll Cardiol. 67 (25): 2996–3010. doi:10.1016/j.jacc.2016.03.590. PMID 27339497.
- ↑ "StatPearls". 2019. PMID 28722940.