Dilated cardiomyopathy: Difference between revisions
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'''Dilated cardiomyopathy''' (<abbr>DCM</abbr>) is a form of [[cardiomyopathy]] characterised by dilation of all four heart chambers, in the absence of [[ischaemic heart disease]], [[hypertension]], [[valvular disease]], and [[congenital heart disease]]. The [[ejection fraction]] is <45% and the left ventricular end-diastolic volume is >117% of | <section begin="radiology" />'''Dilated cardiomyopathy''' (<abbr>DCM</abbr>) is a form of [[cardiomyopathy]] characterised by dilation of all four heart chambers, in the absence of [[ischaemic heart disease]], [[hypertension]], [[valvular disease]], and [[congenital heart disease]]. The [[ejection fraction]] is <45% and the left ventricular end-diastolic volume is >117% of predicted based on body surface area. | ||
DCM is the most common cardiomyopathy, affecting 1/250. The prognosis is poor with a 5-year survival rate of 50%. | DCM is the most common cardiomyopathy, affecting 1/250. The prognosis is poor with a 5-year survival rate of 50%.<section end="radiology" /> | ||
== Etiology == | == Etiology == | ||
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== Clinical features == | == Clinical features == | ||
Patients can be asymptomatic. Symptomatic patients have features of right and/or left-sided heart failure, including fatigue, weakness, exercise intolerance, chest pain, palpitations, and tachycardia. | Patients can be asymptomatic. Symptomatic patients have features of right and/or left-sided heart failure, including fatigue, weakness, exercise intolerance, chest pain, palpitations, and tachycardia. | ||
<section begin="radiology" /> | |||
== Diagnosis and evaluation == | == Diagnosis and evaluation == | ||
[[Chest X-ray|X-ray]] shows enlargement of the cardiac silhouette, and possibly signs of pulmonary congestion. [[Echocardiography]] shows dilation of all four chambers, decreased EF, and secondary mitral and tricuspid regurgitation. | [[Chest X-ray|X-ray]] shows enlargement of the cardiac silhouette, and possibly signs of pulmonary congestion. [[Echocardiography]] shows dilation of all four chambers, decreased EF, and secondary mitral and tricuspid regurgitation. | ||
[[Magnetic resonance imaging|MRI]] is the gold standard for evaluation, as it can measure the volumes of the chambers. It’s also helpful in the evaluation of [[myocarditis]], a common cause. | [[Magnetic resonance imaging|MRI]] is the gold standard for evaluation, as it can measure the volumes of the chambers in addition to showing the dilatation. It’s also helpful in the evaluation of [[myocarditis]], a common cause. | ||
<section end="radiology" /> | |||
== Treatment == | == Treatment == | ||
There is no specific treatment for DCM. If there’s an underlying disease, it should be treated. Treatment for [[heart failure]] is often necessary. Implantation of <abbr>[[Implantable cardioverter defibrillator|ICD]]</abbr> is important to prevent [[sudden cardiac death]] by [[Ventricular fibrillation|V-fib]]. Heart transplant is the only curative treatment. | There is no specific treatment for DCM. If there’s an underlying disease, it should be treated. Treatment for [[heart failure]] is often necessary. Implantation of <abbr>[[Implantable cardioverter defibrillator|ICD]]</abbr> is important to prevent [[sudden cardiac death]] by [[Ventricular fibrillation|V-fib]]. Heart transplant is the only curative treatment. | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Internal Medicine (POTE course)]] | [[Category:Internal Medicine (POTE course)]] | ||
Revision as of 13:14, 28 November 2023
Dilated cardiomyopathy (DCM) is a form of cardiomyopathy characterised by dilation of all four heart chambers, in the absence of ischaemic heart disease, hypertension, valvular disease, and congenital heart disease. The ejection fraction is <45% and the left ventricular end-diastolic volume is >117% of predicted based on body surface area.
DCM is the most common cardiomyopathy, affecting 1/250. The prognosis is poor with a 5-year survival rate of 50%.
Etiology
- Idiopathic
- Familial (genetic) – mutations in cytoskeletal, sarcomeric, nuclear, etc. proteins
- Secondary
- Myocarditis
- Pregnancy (peripartum DCM)
- Alcohol
- Infiltration (sarcoidosis, amyloidosis)
- Cardiotoxic drugs
Pathomechanism
Dilation of the chambers causes systolic heart failure.
Clinical features
Patients can be asymptomatic. Symptomatic patients have features of right and/or left-sided heart failure, including fatigue, weakness, exercise intolerance, chest pain, palpitations, and tachycardia.
Diagnosis and evaluation
X-ray shows enlargement of the cardiac silhouette, and possibly signs of pulmonary congestion. Echocardiography shows dilation of all four chambers, decreased EF, and secondary mitral and tricuspid regurgitation.
MRI is the gold standard for evaluation, as it can measure the volumes of the chambers in addition to showing the dilatation. It’s also helpful in the evaluation of myocarditis, a common cause.
Treatment
There is no specific treatment for DCM. If there’s an underlying disease, it should be treated. Treatment for heart failure is often necessary. Implantation of ICD is important to prevent sudden cardiac death by V-fib. Heart transplant is the only curative treatment.