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| | __NOTOC__ |
| {{Infobox_Disease | | | {{Infobox_Disease | |
| Name = {{PAGENAME}} | | | Name = {{PAGENAME}} | |
| Image = 1151.jpg| | | Image = 1151.jpg| |
| Caption = Dilated Cardiomyopathy: Gross dilated left ventricle with marked endocardial sclerosis <br> <small> [http://www.peir.net Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology] </small>| | | Caption = Dilated Cardiomyopathy: Gross dilated left ventricle with marked endocardial sclerosis <br> <small> [http://www.peir.net Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology] </small>| |
| DiseasesDB = 3066 |
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| ICD10 = {{ICD10|I|42|0|i|30}} |
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| ICD9 = {{ICD9|425.4}} |
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| ICDO = |
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| OMIM = 212110 |
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| MedlinePlus = 000168 |
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| eMedicineSubj = med |
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| eMedicineTopic = 289 |
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| eMedicine_mult = {{eMedicine2|emerg|80}} {{eMedicine2|ped|2502}} |
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| MeshID = D002311 |
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| }} | | }} |
| {{SI}} | | {{Dilated cardiomyopathy}} |
| {{WikiDoc Cardiology Network Infobox}}
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| '''Editor-in-Chief:''' Sachin Shah, M.D.
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| {{Editor Help}}
| | '''For patient information, click [[Dilated cardiomyopathy (patient information)|here]]''' |
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| ==Overview==
| | {{CMG}}; {{AE}}{{AIA}}; Sachin Shah, M.D. |
| '''Dilated cardiomyopathy''' or '''DCM''', also known as '''congestive cardiomyopathy''', is a condition in which the [[heart]] becomes weakened and enlarged, and cannot pump blood efficiently. The decreased heart function can affect the lungs, liver, and other body systems.
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| DCM is one of the [[cardiomyopathy|cardiomyopathies]], a group of diseases that primarily affect the [[myocardium]] (the [[muscle]] of the [[heart]]). Different cardiomyopathies have different causes, and affect the heart in different ways. In DCM a portion of the myocardium is dilated, often without any obvious cause. Left and/or right ventricular [[systolic]] pump function of the heart is impaired, leading to progressive cardiac enlargement and [[Organ hypertrophy|hypertrophy]], a process called ''remodeling''.<ref>Harrison's Principles of Internal Medicine, 16th edition. Kasper, Braunwald, Fauci, Hauser, Longo, Jameson. ISBN 0-07-139140-1</ref>
| | {{SK}} Congestive cardiomyopathy; DCM |
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| Dilated cardiomyopathy is the most common form of cardiomyopathy. It occurs more frequently in men than in women, and is most common between the ages of 20 and 60 years.<ref>Robbins Basic Pathology, 7th edition. Kumar, Cotran, Robbins. ISBN 0-7216-9274-5</ref> About one in three cases of [[congestive heart failure]] (CHF) is due to dilated cardiomyopathy.<ref>Harrison's Principles of Internal Medicine, 16th edition. Kasper, Braunwald, Fauci, Hauser, Longo, Jameson. ISBN 0-07-139140-1</ref> Dilated cardiomyopathy also occurs in children. | | ==[[Dilated cardiomyopathy overview|Overview]]== |
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| ==Causes== | | ==[[Dilated cardiomyopathy historical perspective|Historical Perspective]]== |
| Although no cause ([[etiology]]) is apparent in many cases, dilated cardiomyopathy is probably the end result of damage to the [[myocardium]] produced by a variety of [[toxic]], [[metabolic]], or [[infectious]] agents. It may be the late sequel of acute [[viral]] [[myocarditis]], possibly mediated through an immunologic mechanism.<ref>Martino TA, Liu P, Sole MJ. Viral infection and the pathogenesis of dilated cardiomyopathy. Circ Res. 1994;74:182-8. PMID 8293557
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| </ref> [[Autoimmune]] mechanisms are also suggested as a cause for dilated cardiomyopathy.<ref>San Martin MA, Garcia A, Rodriguez FJ, Terol I. Dilated cardiomyopathy and autoimmunity: an overview of current knowledge and perspectives. Rev Esp Cardiol. 2002;55:514-24. PMID 12015932</ref> A reversible form of dilated cardiomyopathy may be found with [[alcohol]] abuse, [[pregnancy]], [[thyroid disease]], [[stimulant]] use, and [[chronic]] uncontrolled [[tachycardia]]. Many cases of dilated cardiomyopathy are described as ''idiopathic'' - meaning that the cause is unknown.
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| ==Genetics== | | ==[[Dilated cardiomyopathy pathophysiology|Pathophysiology]]== |
| About 20-40% of patients have familial forms of the disease, with [[mutation]]s of genes encoding [[cytoskeletal]], contractile, or other proteins present in myocardial cells.<ref>Ross J Jr. Dilated cardiomyopathy: concepts derived from gene deficient and transgenic animal models. Circ J. 2002;66:219-24. PMID 11922267</ref> The disease is genetically heterogeneous, but the most common form of its transmission is an [[autosomal dominant]] pattern as found, for example, in [[Alström syndrome]].
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| [[Autosomal recessive]], [[X-linked]], and [[Mitochondrial disease|mitochondrial]] inheritance of the disease is also found.<ref>Schonberger J, Seidman CE. Many roads lead to a broken heart: the genetics of dilated cardiomyopathy. Am J Hum Genet. 2001;69:249-60. Epub 2001 Jul 6. PMID 11443548</ref> Relatives of dilated cardiomyopathy patients have been found to show preclinical, asymptomatic heart-muscle changes.<ref>Mahon NG, Murphy RT, MacRae CA, Caforio AL, Elliott PM, McKenna WJ. Echocardiographic evaluation in asymptomatic relatives of patients with dilated cardiomyopathy reveals preclinical disease. Ann Intern Med. 2005;143:108-15. PMID 16027452</ref>
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| Although the disease is more common in African-Americans than in whites,<ref>Coughlin SS, Labenberg JR, Tefft MC. Black-white differences in idiopathic dilated cardiomyopathy: the Washington DC Dilated Cardiomyopathy Study. Epidemiology. 1993;4:165-72. PMID 8452906</ref> it may occur in any patient population.
| | ==[[Dilated cardiomyopathy causes|Causes]]== |
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| ==Associated symptoms== | | ==[[Dilated cardiomyopathy differential diagnosis|Differentiating Dilated cardiomyopathy from other Diseases]]== |
| For many affected individuals, dilated cardiomyopathy is a condition which will not limit the quality or duration of life. A minority, however, experience significant symptoms and there is sometimes a risk of sudden death. Evaluation by a cardiologist is recommended to confirm the diagnosis and to assess the outlook and particularly the risk of complications. In some patients symptoms of left- and right-sided congestive heart failure develop gradually. Left ventricular dilatation may be present for months or even years before the patient becomes symptomatic.
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| Vague chest pain may be present, but typical [[angina pectoris]] is unusual and suggests the presence of concomitant [[ischemic heart disease]]. [[Syncope]] due to [[Cardiac arrhythmia|arrhythmias]], and systemic [[embolism]] may occur.
| | ==[[Dilated cardiomyopathy epidemiology and demographics|Epidemiology and Demographics]]== |
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| ==Physical examination== | | ==[[Dilated cardiomyopathy risk factors|Risk Factors]]== |
| The patient may present variable degrees of cardiac enlargement, and findings of [[congestive heart failure]]. In advanced stages of the disease, the [[pulse pressure]] is narrowed and the [[jugular venous pressure]] is elevated. Third and fourth heart sounds are common. [[Mitral]] or [[tricuspid]] [[regurgitation]] may occur, presented by systolic [[murmur]]s upon [[auscultation]] (see [[mitral regurgitation]] and [[tricuspid insufficiency]] for more details about the findings).
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| ==Laboratory examinations== | | ==[[Dilated cardiomyopathy screening|Screening]]== |
| Generalized enlargement of the heart is seen upon normal [[chest X-ray]]. [[Pleural effusion]] may also be noticed, which is due to pulmonary venous hypertension.
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| The [[electrocardiogram]] often shows [[sinus tachycardia]] or [[atrial fibrillation]], [[Cardiac arrhythmia#List of common cardiac dysrhythmias|ventricular arrhythmia]]s, left atrial abnormality, and sometimes intraventricual conduction defects and low voltage. [[Echocardiogram]] shows left ventricular dilatation with normal or thinned walls and reduced [[ejection fraction]]. Cardiac [[catheterization]] and [[coronary angiography]] are often performed to exclude ischemic heart disease.
| | ==[[Dilated cardiomyopathy natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==Treatment== | | ==Diagnosis== |
| Years ago the statistic was that the majority of patients, particularly those over 55 years of age, died within 3 years of the onset of symptoms (stage 5 of CHF) – and such figures can still be found in many textbooks. The situation has improved dramatically in recent years with drug therapy that can slow down progression and in some cases even improve the heart condition. Death is due to either [[congestive heart failure]] or ventricular [[tachyarrhythmia|tachy-]] or [[bradyarrhythmia]]s.
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| Patients are given the standard therapy for heart failure, typically including salt restriction, [[angiotensin-converting enzyme]] (ACE) inhibitors, [[diuretic]]s, and [[digitalis]]. [[Anticoagulation|Anticoagulants]] may also be used. Alcohol should be avoided. [[Artificial pacemaker]]s may be used in patients with intraventricular conduction delay, and [[implantable cardioverter-defibrillator]]s in those at risk of arrhythmia. These forms of treatment have been shown to improve symptoms and reduce hospitalization.
| | [[Dilated cardiomyopathy history and symptoms|History and Symptoms]] | [[Dilated cardiomyopathy physical examination|Physical Examination]] | [[Dilated cardiomyopathy laboratory findings|Laboratory Findings]] | [[Dilated cardiomyopathy electrocardiogram|Electrocardiogram]] | [[Dilated cardiomyopathy chest x ray|Chest X-Ray]] | [[Dilated cardiomyopathy CT|CT]] | [[Dilated cardiomyopathy MRI|MRI]] | [[Dilated cardiomyopathy echocardiography|Echocardiography]] | [[Dilated cardiomyopathy other imaging findings|Other Imaging Findings]] | [[Dilated cardiomyopathy genetic testing|Genetic testing]] | [[Dilated cardiomyopathy other diagnostic studies|Other Diagnostic Studies]] |
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| In patients with advanced disease who are refractory to medical therapy, cardiac [[transplantation]] may be considered.
| | ==Treatment== |
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| === Reverse remodeling === | |
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| The progression of heart failure is associated with left ventricular remodeling, which manifests as gradual increases in left ventricular end-diastolic and end-systolic volumes, wall thinning, and a change in chamber geometry to a more spherical, less elongated shape. This process is usually associated with a continuous decline in [[ejection fraction]]. The concept of cardiac remodeling was initially developed to describe changes which occur in the days and months following myocardial infarction. It has been extended to cardiomyopathies of non-ischemic origin, such as idiopathic dilated cardiomyopathy or chronic myocarditis, suggesting common mechanisms for the progression of cardiac dysfunction. Literally, reverse remodeling is the process of reversing the remodeling, or in other words, it is a process of a temporary or a permanent correction of the heart. A 2004 article gives a description of the current therapies that support reverse remodeling and suggests a new approach to the prognosis of cardiomyopathies.<ref> Pieske B. Reverse remodeling in heart failure – fact or fiction? Eur Heart J Suppl. 2004;6:D66-D68. ([http://eurheartjsupp.oxfordjournals.org/cgi/content/abstract/6/suppl_D/D66 full text online])</ref>
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| === Alternative treatment ===
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| [[alternative medicine|Alternative treatments]] are promoted by some, including food supplements [[Coenzyme Q10]], [[L-Carnitine]], [[Taurine]] and D-Ribose, and there is some evidence for the benefits of Coenzyme Q10 in treating heart failure.<ref>Langsjoen PH, Langsjoen PH, Folkers K. A six-year clinical study of therapy of cardiomyopathy with coenzyme Q10. Int J Tissue React. 1990;12:169-71. PMID 2276895</ref><ref>Folkers K, Langsjoen P, Langsjoen PH. Therapy with coenzyme Q10 of patients in heart failure who are eligible or ineligible for a transplant. Biochem Biophys Res Commun. 1992;182:247-53. PMID 1731784</ref><ref>Baggio E, Gandini R, Plancher AC, Passeri M, Carmosino G. Italian multicenter study on the safety and efficacy of coenzyme Q10 as adjunctive therapy in heart failure. CoQ10 Drug Surveillance Investigators. Mol Aspects Med. 1994;15 Suppl:s287-94. PMID 7752841</ref> The majority of doctors doubt the effectiveness of these alternative treatments, but a few complement conventional treatment by suggesting Coenzyme Q10.
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| ==Gross Pathological Findings==
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| Images shown below are Courtesy of Professor Peter Anderson DVM PhD and published with permission. [http://www.peir.net © PEIR, University of Alabama at Birmingham, Department of Pathology]
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:414.jpg|Cardiomyopathy: Gross excellent view of mitral valve from left atrium anterior leaflet appears to balloon a bit into the atrium
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| Image:415.jpg|Cardiomyopathy: Gross excellent view of mitral and tricuspid valves from atria, appear normal anatomy.
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:6621.jpg|Dilated Cardiomyopathy: Gross natural color close-up view of heart surgically removed for a transplantation shows aortic valve and anterior leaflet of mitral valve with cholesterol deposits endocardium of left ventricle is diffusely thickened
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| Image:434.jpg|Cardiomyopathy: Gross external view of globular heart with patchy fibrosis seen through epicardium
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:874.jpg|Cardiomyopathy: Gross dilated left ventricle with marked endocardial thickening this is what has been called adult fibroelastosis
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| Image:1134.jpg|Dilated Cardiomyopathy: Gross good example huge dilated left ventricle
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:1151.jpg|Dilated Cardiomyopathy: Gross dilated left ventricle with marked endocardial sclerosis (an excellent example)
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| Image:1457.jpg|Cardiomyopathy: Gross intact globular shaped heart
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:1489.jpg|Dilated Cardiomyopathy: Gross opened left ventricle dilated with endocardial thickening good example
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| Image:1509.jpg|Cardiomyopathy: Gross globular heart external view 10 year old girl with sickle cell anemia
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| </gallery>
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| </div>
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| | [[Dilated cardiomyopathy medical therapy|Medical Therapy]] | [[Dilated cardiomyopathy surgery|Surgery]] | [[Dilated cardiomyopathy primary prevention|Primary Prevention]] | [[Dilated cardiomyopathy secondary prevention|Secondary Prevention]] | [[Dilated cardiomyopathy cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Dilated cardiomyopathy future or investigational therapies|Future or Investigational Therapies]] |
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| <div align="left">
| | ==Case Studies== |
| <gallery heights="175" widths="175">
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| Image:1510.jpg|Cardiomyopathy: Gross horizontal sections of ventricles dilation type 10 year old girl with sickle cell anemia
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| Image:2367.jpg|Cardiomyopathy: Intermediate between hypertrophic and dilated
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| </gallery>
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| </div>
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| | [[Dilated cardiomyopathy case study one|Case #1]] |
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| <div align="left">
| | ==Related Chapters== |
| <gallery heights="175" widths="175">
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| Image:2665.jpg|Dilated Cardiomyopathy: Gross opened globular left ventricle natural color (very good example)
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| Image:2221.jpg|Brain: Infarct: Healing large MCA and PICA probably embolic 64 year old female chronic obstructive pulmonary disease and cardiomyopathy with atrial fibrillation
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:8777.jpg|Kidney: Infarct Remote: Gross external view with capsule removed two old and very typical infarct scars 27yobf with dilated cardiomyopathy
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| Image:6224.jpg|Dilated Cardiomyopathy: Gross natural color external view globular heart 500 gm 24yo female seven pregnancies
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| </gallery>
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| </div>
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| ==References==
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| {{Reflist|2}}
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| ==See Also==
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| * [[Cardiomyopathy]] | | * [[Cardiomyopathy]] |
| * [[Hypertrophic cardiomyopathy]] | | * [[Hypertrophic cardiomyopathy]] |
| | * [[Stress cardiomyopathy]] |
| | * [[Anticoagulation in patients with dilated cardiomyopathy]] |
| | * [[First degree AV block]] |
| | * [[Second degree AV block]] |
| | * [[Beriberi heart disease]] |
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| ==External links==
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| * [http://www.cardiomyopathy.org/html/which_card_dcm.htm Cardiomyopathy Association: Dilated cardiomyopathy]
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| * [http://www.childrenscardiomyopathy.org Children's Cardiomyopathy Foundation]
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| ==Additional Reading==
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| * Moss and Adams' Heart Disease in Infants, Children, and Adolescents Hugh D. Allen, Arthur J. Moss, David J. Driscoll, Forrest H. Adams, Timothy F. Feltes, Robert E. Shaddy, 2007 ISBN 0781786843
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| * Braunwald's Heart Disease, Libby P, 8th ed., 2007, ISBN 978-1-41-604105-4
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| * Hurst's the Heart, Fuster V, 12th ed. 2008, ISBN 978-0-07-149928-6
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| * Willerson JT, Cardiovascular Medicine, 3rd ed., 2007, ISBN 978-1-84628-188-4
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| {{clr}}
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| {{Circulatory system pathology}} | | {{Circulatory system pathology}} |
| {{SIB}}
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| [[ru:Дилатационная кардиомиопатия]] | | [[ru:Дилатационная кардиомиопатия]] |
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| | [[Category:Disease]] |
| [[Category:Cardiomyopathy]] | | [[Category:Cardiomyopathy]] |
| [[Category:Cardiology]] | | [[Category:Cardiology]] |
| | | [[Category:Up-To-Date cardiology]] |
| | [[Category:Up-To-Date]] |
| {{WikiDoc Help Menu}} | | {{WikiDoc Help Menu}} |
| {{WikiDoc Sources}} | | {{WikiDoc Sources}} |
