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. | ||
==History== | ==History and Symptoms== | ||
In terms of determining the etiology a careful history is most instrumental. 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. 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. Screening questions regarding [[cocaine]] or [[alcohol]] abuse or other [[toxin]] exposure (such as [[cobalt]]) should be addressed. | In terms of determining the etiology a careful history is most instrumental. 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. 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. 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 heart failure are most common. Usually, they develop slowly over time. However, sometimes symptoms start very suddenly and are severe. | ||
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*[[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 | ||
*Swelling of feet and ankles (in adults) | *Swelling of feet and ankles (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. 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). | |||
[[Angina]] is not a common feature of dilated cardiomyopathy unless the cause is related to coronary artery disease. If angina is present a work up for [[cardiac ischemia]] should be undertaken.<ref> Mayo Clinic Cardiology. Concise Textbook. Murphy, Joseph G; Lloyd, Margaret A. Mayo Clinic Scientific Press. 2007.</ref> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 19:58, 18 January 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-in-Chief: Sachin Shah, M.D.
History and Symptoms
In terms of determining the etiology a careful history is most instrumental. 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. 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. 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 are:
- 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
- Swelling of feet and ankles (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. 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).
Angina is not a common feature of dilated cardiomyopathy unless the cause is related to coronary artery disease. If angina is present a work up for cardiac ischemia should be undertaken.[1]
References
- ↑ Mayo Clinic Cardiology. Concise Textbook. Murphy, Joseph G; Lloyd, Margaret A. Mayo Clinic Scientific Press. 2007.