• Dilated Cardiomyopathy

    by  • 24/08/2013 • Cardiology

    Definition

    Characterised by dilatation and impaired systolic function of the left and/or right ventricle.

    Rule out: abnormal loading conditions (hypertension, valve disease) and coronary disease. Must have NORMAL valves and coronaries to qualify.

    Presentation

    1. o Congestive heart failure and therefore symptoms are of left and/or right heart failure.
    2. o Syncope due to ventricular arrhythmia or conduction disease
    3. o Pulmonary or systemic embolism
    4. o Sudden death

     

    Diagnostic/Investigation

    1. Chest xray
      1. Generalised cardiac (ventricular) enlargement (=dilation)
    2. ECG
      1. Diffuse non-specific ST segment and T wave changes.
      2. Sinus tachycardia
      3. Conduction abnormalities
      4. Ventricular arrhythmias
    3. Echocardiogram
      1. Dilation of left and/or right ventricle with poor global contraction function
    4. Angiography
      1. Performed to exclude coronary artery disease in all individuals at risk

     

    Aetiology – cause, risk factors

    Cause is unknown in the majority of cases = idiopathic

    Genetic Autosomal dominant DCM

     

    X-linked cardiomyopathy
    Inflammatory Post-infective

    Autoimmune

    Connective tissue disease (SLE, systemic sclerosis)

    Metabolic Glycogen storage disease
    Nutritional Thiamin deficiency

    Selenium deficiency

    Endocrine Acromegaly

    Thyrotoxicosis

    Myxoedema

    Diabetes mellitus

    Infiltrative Hereditary haemochromatosis
    Neuromuscular Muscular dystrophy

    Friedreich’s ataxia

    Mitochondrial myopathies

    Toxic Alcohol

    Cocaine

    Doxorubicin

    Cyclophosphamide

    Cobalt

    Haematological Sickle cell anaemia

    Thrombotic thrombocytopenic purpura

     

    Treatment/management

    Goals are to relieve symptoms, stop disease progression and prevent complications.

    1. Diuretics
      1. o Relieve congestive symptoms
      2. o Do not use in isolation as exacerbate activation of neurohormones that may contribute to disease progression.
    2. ACE inhibitors, ARBS, spironolactone, beta-blockers
      1. o Stop progression of disease
      2. o Beta blockers also prevent arrhythmias

     

    Cardiac transplant for advanced disease if medical therapy doesn’t work. 

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