Dilated cardiomyopathy resident survival guide: Difference between revisions
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:❑ Urinalysis</div>}} | :❑ Urinalysis</div>}} | ||
{{familytree | | | | | | | | F01 | |F01=<div style="text-align: left;"><b><u>Imaging and additional tests:</u></b><br> | {{familytree | | | | | | | | F01 | |F01=<div style="text-align: left;"><b><u>Imaging and additional tests:</u></b><br> | ||
❑ <b>Noninvasive imaging:</b> | |||
❑ Noninvasive imaging: | :❑ Chest x-ray (heart size, pulmonary congestion and alternative cardiac, pulmonary, and other diseases?) | ||
:❑ Chest x-ray(heart size, pulmonary congestion and alternative cardiac, pulmonary, and other diseases?) | |||
:❑ 2-dimensional echocardiogram with Doppler (ventricular function, size, wall thickness, wall motion, and valve function?) | :❑ 2-dimensional echocardiogram with Doppler (ventricular function, size, wall thickness, wall motion, and valve function?) | ||
::❑ Repeat measurement of EF and severity of structural remodeling (after significant change in clinical status, after clinical event, after treatment or if candidates for device therapy) | ::❑ Repeat measurement of EF and severity of structural remodeling (after significant change in clinical status, after clinical event, after treatment or if candidates for device therapy) | ||
:❑ Cardiac-MRI (ventricular size, wall/muscle thickness, valves, pericardium, wall motion, etc.) | :❑ Cardiac-MRI (ventricular size, wall/muscle thickness, valves, pericardium, wall motion, etc.) | ||
::❑ Consider check for myocardial ischemia and viability for patients with known CAD and no angina | ::❑ Consider check for myocardial ischemia and viability for patients with known CAD and no angina | ||
::❑ Viability assessment when planning revascularization in HF patients with CAD | ::❑ Viability assessment when planning revascularization in HF patients with CAD | ||
::❑ Radionuclide ventriculography or magnetic resonance imaging can be useful to assess LVEF and volume when echocardiography is inadequate | ::❑ Radionuclide ventriculography or magnetic resonance imaging can be useful to assess LVEF and volume when echocardiography is inadequate | ||
::❑ Consider magnetic resonance imaging when assessing myocardial infiltrative processes or scar burden | |||
❑ <b>Invasive imaging:</b> | |||
Consider invasive Imaging only in specific cases. | |||
:❑ Invasive hemodynamic monitoring with a pulmonary artery catheter to guide therapy in patients with respiratory distress or clinical evidence of impaired perfusion if the adequacy or excess of intracardiac filling pressures cannot be determined from clinical assessment | |||
::❑ Consider carefully invasive hemodynamic monitoring for patients with persistent symptoms despite empiric adjustment of standard therapies/ if fluid status, perfusion, or systemic or pulmonary vascular resistance is uncertain/systolic pressure remains low, or is associated with symptoms, despite initial therapy/if renal function is worsening with therapy/ if parenteral vasoactive agents are required/ if consideration for MCS or transplantation/ if ischemia contributes to HF coronary arteriography for patients who are eligible for revascularization | |||
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Revision as of 18:34, 5 March 2015
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Steven Bellm, M.D. [2]
Dilated cardiomyopathy resident survival guide Microchapters |
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Overview |
Causes |
Diagnosis |
Treatment |
Do's |
Dont's |
Overview
Dilated cardiomyopathy (DCM) relates to a group of heterogeneous myocardial disorders and is characterized by dilatation and impaired contraction and systolic function of the left or both ventricles. Atrial and/or ventricular arrhythmias can occcur, and there is a risk for sudden death. [1] The weight of the heart is increased but the maximal thicknesses of the left ventricular free wall and septum are usually normal as a result of the abnormally dilated chambers.[2]
Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.[3]
- Life-threatening causes:
- Common causes:
- Idiopathic
- Myocarditis
- Ischemic heart disease
- Infiltrative disease
- Peripartum cardiomyopathy
- Hypertension
- Human immunodeficiency virus (HIV) infection
- Connective tissue disease
- Substance abuse
- Doxorubicin
- Other
Complete Diagnostic Approach
A complete diagnostic approach should be carried out after a focused initial rapid evaluation is conducted and following initiation of any urgent intervention.[4]
Symptoms of heart failure | |||||||||||||||||||||||||||||||||
History and symptoms: ❑ Hints for etiology (family history, and others)
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Physical examination: ❑ Vital signs:
❑ General appearance:
❑ Heart:
❑ Lungs:
❑ Abdomen:
❑ Extremities:
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Laboratory findings: ❑ Complete blood count
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Imaging and additional tests: ❑ Noninvasive imaging:
❑ Invasive imaging: Consider invasive Imaging only in specific cases.
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C01 | |||||||||||||||||||||||||||||||||
Treatment
shown
hidden
Do's
Dont's
References
- ↑ "Report of the WHO/ISFC task force on the definition and classification of cardiomyopathies". Br Heart J. 44 (6): 672–3. 1980. PMC 482464. PMID 7459150.
- ↑ Tazelaar HD, Billingham ME (1986). "Leukocytic infiltrates in idiopathic dilated cardiomyopathy. A source of confusion with active myocarditis". Am J Surg Pathol. 10 (6): 405–12. PMID 3521345.
- ↑ Felker GM, Thompson RE, Hare JM, Hruban RH, Clemetson DE, Howard DL; et al. (2000). "Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy". N Engl J Med. 342 (15): 1077–84. doi:10.1056/NEJM200004133421502. PMID 10760308.
- ↑ Yancy, C. W.; Jessup, M.; Bozkurt, B.; Butler, J.; Casey, D. E.; Drazner, M. H.; Fonarow, G. C.; Geraci, S. A.; Horwich, T.; Januzzi, J. L.; Johnson, M. R.; Kasper, E. K.; Levy, W. C.; Masoudi, F. A.; McBride, P. E.; McMurray, J. J. V.; Mitchell, J. E.; Peterson, P. N.; Riegel, B.; Sam, F.; Stevenson, L. W.; Tang, W. H. W.; Tsai, E. J.; Wilkoff, B. L. (2013). "2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. 128 (16): e240–e327. doi:10.1161/CIR.0b013e31829e8776. ISSN 0009-7322.