Dilated cardiomyopathy natural history, complications and prognosis: Difference between revisions
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 |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Dilated cardiomyopathy natural history, complications and prognosis On the Web |
|
American Roentgen Ray Society Images of Dilated cardiomyopathy natural history, complications and prognosis |
|
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 |
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
-
Kidney: Infarct Remote: Gross external view with capsule removed two old and very typical infarct scars 27 year old person with dilated cardiomyopathy -
Brain: Infarct: Healing large MCA and PICA probably embolic 64 year old female chronic obstructive pulmonary disease and cardiomyopathy with atrial fibrillation
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
- ↑ Mayo Clinic Cardiology. Concise Textbook. Murphy, Joseph G; Lloyd, Margaret A. Mayo Clinic Scientific Press. 2007.