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. | ||
* 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. | ||
* 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]]. | ||
* 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 === | ||
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*[[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. | 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). | |||
=== 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> Mayo Clinic Cardiology. Concise Textbook. Murphy, Joseph G; Lloyd, Margaret A. Mayo Clinic Scientific Press. 2007.</ref> | |||
==References== | ==References== |
Revision as of 18:04, 16 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.
- 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
- 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.
- 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.[1]
References
- ↑ Mayo Clinic Cardiology. Concise Textbook. Murphy, Joseph G; Lloyd, Margaret A. Mayo Clinic Scientific Press. 2007.