Dilated cardiomyopathy natural history, complications and prognosis: Difference between revisions

Jump to navigation Jump to search
No edit summary
Line 9: Line 9:


=== Natural History ===
=== Natural History ===
[[Dilated cardiomyopathy]] is the final common pathway for different etiologic mechanisms. During the initial visit of a patient with [[Dilated cardiomyopathy|DCM]], the clinician should in fact consider all the potentially reversible causes of left [[ventricular dysfunction]], likely to benefit from specific therapeutic intervention. The onset of DCM can be at times indistinguishable from other conditions which can be specifically recovered by correcting the underlying problem.The natural history of DCM has thus significantly changed in the last few years, particularly after the introduction and utilization of [[ACE inhibitor|ACE-inhibitors]], [[Beta blockers|betablockers]], anti-[[Aldosterone antagonist|aldosterone]] drugs and nonpharmacological treatments, such as [[Cardiac resynchronization therapy|cardiac resynchronization]] (CRT) and [[Implantable cardioverter defibrillator|implantable defibrillator]] (ICD). However, still about 2% of patients with DCM died of [[sudden cardiac death]] after the diagnosis and the risk of other complications as [[Congestive heart failure|heart failure]], arterial [[infarction]]<nowiki/>s, and valvular insufficiency remains high.


=== Complications ===
=== Complications ===

Revision as of 14:15, 30 December 2019

Dilated cardiomyopathy Microchapters

Home

Patient Information

Overview

Historical Perspective

Pathophysiology

Classification

Causes

Differentiating Dilated cardiomyopathy from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Dilated cardiomyopathy natural history, complications and prognosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Dilated cardiomyopathy natural history, complications and prognosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Dilated cardiomyopathy natural history, complications and prognosis

CDC on Dilated cardiomyopathy natural history, complications and prognosis

Dilated cardiomyopathy natural history, complications and prognosis in the news

Blogs on Dilated cardiomyopathy natural history, complications and prognosis

Directions to Hospitals Treating Dilated cardiomyopathy

Risk calculators and risk factors for Dilated cardiomyopathy natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Abdelrahman Ibrahim Abushouk, MD[2]

Overview

There are several prognostic indicators when evaluating dilated cardiomyopathy, the most important one being ejection fraction. Complications as a result of dilated cardiomyopathy include heart failure, aortic and mitral valve regurgitation, emboli, edema, arrhythmias and sudden cardiac arrest.

Natural History, Complications, and Prognosis

Natural History

Dilated cardiomyopathy is the final common pathway for different etiologic mechanisms. During the initial visit of a patient with DCM, the clinician should in fact consider all the potentially reversible causes of left ventricular dysfunction, likely to benefit from specific therapeutic intervention. The onset of DCM can be at times indistinguishable from other conditions which can be specifically recovered by correcting the underlying problem.The natural history of DCM has thus significantly changed in the last few years, particularly after the introduction and utilization of ACE-inhibitors, betablockers, anti-aldosterone drugs and nonpharmacological treatments, such as cardiac resynchronization (CRT) and implantable defibrillator (ICD). However, still about 2% of patients with DCM died of sudden cardiac death after the diagnosis and the risk of other complications as heart failure, arterial infarctions, and valvular insufficiency remains high.

Complications

Prognosis

There are many prognostic factors which can be evaluated in a patient with dilated cardiomyopathy.[1] The most important prognostic indicator is a decreased ejection fraction, in addition increased left ventricular size and right ventricular dilation are independent indicators of a poor prognosis. As is in most types of heart failure a poor NYHA functional class and increased PASP (>35mmHg) are also poor prognostic indicators. Other findings that infer a poor prognosis are as follows: Maximal O2 uptake of < 12mL/kg / minute on exercise testing, LBBB (left bundle branch block), non sustained ventricular tachycardia, syncope, hyponatremia with a serum sodium less than 135, elevated norepinephrine, ANP (atrial natriuretic peptide) and renin levels (not routinely measured in clinical practice), elevated PCWP (pulmonary capillary wedge pressure) > 18mmHg and low cardiac index < 2.5L/min/m^2.

References

  1. Mayo Clinic Cardiology. Concise Textbook. Murphy, Joseph G; Lloyd, Margaret A. Mayo Clinic Scientific Press. 2007.

Template:WH Template:WS