Dilated Cardiomyopathy

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Features

-  Type of cardiomyopathy

-  Cardiac enlargement due to ventricular dilation with minor hypertrophy

-  Enlargement of all chambers

-  Decreased contractile function

 

Associated S/S

-  Tachycardia: compensation for poor CO

-  Thrusting apex beat

-  Heart failure S/S

-  Pulmonary congestion: CCF

-  Systemic congestion: oedema, ascities, elevated JVP

-  Fatigue, weakness: poor CO

-  AF: left atrial dilation

-  Cardiomegaly: left displaced apex beat

-  s3

 

Causes

-  Idiopathic

-  Genetic

-  AD or AR, X linked, mitochondrial

-  Inflammatory

-  Acute viral myocarditis

-  Young prev healthy

-  Coxsachie group B, echo virus

-  Typically self limited w full recovery

-  Only very few get dilated cardiomyopathy

-  Noninfectious

-  Connective tissue disease

-  Peripartum cardiomyopathy

-  Sarcoidosis

-  Toxic

-  Alcohol

-  Chronic ingestion

-  Reversible

-  Haemochromatosis

-  Antipsychotics

-  Chemotherapy

-  Doxorubicin..

-  Metabolic

-  Hypothyroidism

-  Chronic Hypocalcaemia or hypophosphataemia

-  Muscular dystrophy

 

Ix

-  CXR: Cardiomegaly, pulmonary oedema

-  ECG

-  Atrial enlargement: tall P = left, wide P = right

-  Ventricular enlargement: Left axis deviation = left, Right axis deviation = right

-  AF, VT

-  LBBB, RBBB

-  Diffuse ST & T wave abnormalities

-  Local Q waves: myocardial fibrosis

-  Echo: enlargement, global systolic contraction, MR, TR

-  Angiogram: pts w angina, +/- biopsy

-  Transvenous right ventricular biopsy: viral myocarditis (active inflammation)

-  Serology: coxsachie B RNA

-  LFTs: alcoholic cardiomyopathy

-  TFTs, CMP: metabolic screen

-  Autoimmune screen

 

Mx

-  Underlying cause

-  Salt restriction

-  Diuretics

-  ACEI: 1st line

-  ARB: 2nd line

-  Hydralazine + Isosorbide dinitrate: 3rd line