Dilated cardiomyopathy resident survival guide
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 |
---|
Overview |
Causes |
Diagnosis |
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 assessed by the MRI and echocardiogram 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]Dilated cardiomyopathy is treated the same way that congestive heart failure is.
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 (at least 3 generations of family history, and others) | |||||||||||||||||||||||||||||||||||||||||
Physical examination: ❑ Vital signs:
❑ General appearance:
❑ Heart:
❑ Lungs:
❑ Abdomen:
❑ Extremities:
| |||||||||||||||||||||||||||||||||||||||||
Laboratory findings: ❑ Complete blood count
| |||||||||||||||||||||||||||||||||||||||||
Imaging and additional tests: ❑ Noninvasive imaging:
❑ Invasive imaging: Consider invasive Imaging only in specific cases.
| |||||||||||||||||||||||||||||||||||||||||
Examples for specific findings for dilated cardiomyopathy:
❑ Echo (dilated left and/or right ventricle, global hypokinesis with left ventricular ejection fraction under 40% | |||||||||||||||||||||||||||||||||||||||||
Rapidly progressive symptoms (within 1 month)? And/or new ventricular tachycardia? | |||||||||||||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||||||||||||
Consider endomyocardial biopsy | Treat with conventional heart failure medications | ||||||||||||||||||||||||||||||||||||||||
Clinical improvement after 1 week? | |||||||||||||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||||||||||||
Continue conventional heart failure treatment | Consider endomyocardial biopsy | ||||||||||||||||||||||||||||||||||||||||
Do's
- The initial diagnostic approach should aim to identify potentially reversible causes of left ventricular dysfunction. Pertinent history includes alcohol consumption, recent viral illness, coronary risk factors, and family history.
Dont's
- Endomyocardial biopsy should not be performed in the routine evaluation of patients with HF.[4] Optimal timing of endomyocardial biopsy on patients unresponsive to medical therapy remains unclear.[3]
- Nondihydropyridine calcium channel blockers with negative inotropic effects may be harmful in asymptomatic patients with low LVEF and no symptoms of HF after MI.[5]
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.
- ↑ 3.0 3.1 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.
- ↑ 4.0 4.1 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.
- ↑ WRITING COMMITTEE MEMBERS. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE; et al. (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): e240–327. doi:10.1161/CIR.0b013e31829e8776. PMID 23741058.