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Dilated Cardiomyopathy

Title               

Ñ    Dilated Cardiomyopathy

Definition

Ñ    Dilatation of the left and or right ventricle with impaired contraction

Ñ    No abnormal loading conditions such as hypertension or valvular disease

Ñ    No coronary artery disease

Pathogenesis

Causes

Genetic disorders

Ñ    Autosomal dominant dilated cardiomyopathy

Ñ    X-linked cardiomyopathy

Systemic Factors

LMS

Ñ    Systemic lupus erythematosus

Ñ    Systemic sclerosis

E&M

Ñ    Acromegaly

Ñ    Thyrotoxicosis

Ñ    Hypothyroidism

Ñ    Diabetes mellitus

Ñ    Haemochromatosis

Ñ    Thiamine deficiency

Ñ    Selenium deficiency

CNS

Ñ    Muscular dystrophy

Ñ    Friedrich’s ataxia

Ñ    Mitochondrial myopathies

HS

Ñ    Sickle cell anaemia

Ñ    Thrombotic thrombocytopaenic purpura

Toxins

Ñ    Alcohol

Ñ    Cocaine

Drugs

Ñ    Doxorubicin

Ñ    Cyclophosphamide

Pathophysiology

Ñ    Systolic dysfunction and ventricular enlargement with normal left ventricle wall thickness

Ñ    Systolic dysfunction and ventricular enlargement leads to progressive heart failure

Clinical Features

History

Age

Ñ    May occur at any age

Sex

Ñ    Males = Females

CVS

Ñ    Syncope

Ñ    Fatigue

Ñ    Breathlessness

Ñ    Decreased exercise tolerance

Ñ    Swelling of the peripheries and abdomen

Examination

CVS

Ñ    Dependent oedema

Ñ    Atrial fibrillation

Ñ    Low volume pulse

Ñ    Pulsus alternans

Ñ    Low pulse pressure

Ñ    JVP elevated:

V wave

Ñ    Displaced apex

Ñ    4^th sound initially, later 3^rd heart sound

Ñ    Reversed splitting of 2^nd heart sound:

Left bundle branch block

Ñ    Loud P₂:

Pulmonary hypertension

Ñ    Murmurs of mitral and tricuspid regurgitation

RS

Ñ    Bilateral basal crepitations

GIT

Ñ    Hepatomegaly

Ñ    Ascites

Complications

Ñ    Systemic emboli

Investigations

Imaging

Chest X-ray

Ñ    Dilated heart

ECHO

Ñ    Dilatation of ventricles with poor contraction

Angiography

Ñ    To exclude coronary artery disease

Electrophysiology

ECG

Ñ    Diffuse non-specific ST, T wave changes

Ñ    Sinus tachycardia

Ñ    Atrial fibrillation

Ñ    Conduction defects

Tissue Diagnosis

Ñ    Not usually indicated

Management

Control

Drugs

Ñ    Diuretics

Ñ    ACE inhibitors

Ñ    Beta-blockers

Ñ    Digoxin

Ñ    Anticoagulation

Biological Agents

Ñ    Heart transplantation

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