Dilated cardiomyopathy

Cardiovascular

Clinicals - History

Fact Explanation
Fatigue In this disease, the left ventricle is dilated, and more spherical than usual with raised wall stress and depressed systolic function. When the disease progressed with time patient develop signs and symptoms of heart failure. Exertional fatigue occurs due to the under - perfusion of the skeletal muscles. Fatigue
In this disease, the left ventricle is dilated, and more spherical than usual with raised wall stress and depressed systolic function. When the disease progressed with time patient develop signs and symptoms of heart failure. Exertional fatigue occurs due to the under - perfusion of the skeletal muscles.
Shortness of breath on exercion In dilated cardiomyopathy the left ventricle is dilated and the ejection fraction is reduced which leads to the pulmonary congestion and reduced blood gas exchange. Shortness of breath on exercion
In dilated cardiomyopathy the left ventricle is dilated and the ejection fraction is reduced which leads to the pulmonary congestion and reduced blood gas exchange.
Orthopnea When the patient is lying down pulmonary congestion increases upto a level where the patient feels difficulty in breathing when lying down and but it gets relieved in a sitting up position. Orthopnea
When the patient is lying down pulmonary congestion increases upto a level where the patient feels difficulty in breathing when lying down and but it gets relieved in a sitting up position.
Peripheral odema When the heart fails to maintain cardiac output and peripheral tissue perfusion there is expansion of extracellular fluid volume secondary to the salt and water retention. Peripheral odema
When the heart fails to maintain cardiac output and peripheral tissue perfusion there is expansion of extracellular fluid volume secondary to the salt and water retention.
Chest pain Occurs due to ischemia. Elevated filling pressures, increased heart rate,
decreased coronary perfusion pressure, and increasing left ventricular mass out of proportion to microvasculature cause ischemia.
Chest pain
Occurs due to ischemia. Elevated filling pressures, increased heart rate,
decreased coronary perfusion pressure, and increasing left ventricular mass out of proportion to microvasculature cause ischemia.
Sudden cardiac death, Due to the dilation of the heart, normal architecture of the cardiac muscle is disrupted and conduction tissues system get disorganize and cause ventricular fibrillation. Sudden cardiac death,
Due to the dilation of the heart, normal architecture of the cardiac muscle is disrupted and conduction tissues system get disorganize and cause ventricular fibrillation.
Family history Familial dilated cardiomyopathy has a genetic basis. Therefore in the history it is important to know about family history of cardiomyopathy or any unexplained sudden death. Family history
Familial dilated cardiomyopathy has a genetic basis. Therefore in the history it is important to know about family history of cardiomyopathy or any unexplained sudden death.
History of hypertention In hypertension cardiac muscle remodeling occurs therefore patient with a history of hypertension has an increased risk of developing dilated cardiomyopathy. History of hypertention
In hypertension cardiac muscle remodeling occurs therefore patient with a history of hypertension has an increased risk of developing dilated cardiomyopathy.
History of thyrotoxicosis The heart is sensitive to changes in thyroid hormones, and cardiac disorders are commonly associated with both hyper- or hypothyroidism. Left ventricular systolic function is minimally decreased with slightly reduced ejection fraction and stroke volume due to thyroid levels and dilated cardiomyopathy can be a rare presentation of hyper/hypothyroidism. History of thyrotoxicosis
The heart is sensitive to changes in thyroid hormones, and cardiac disorders are commonly associated with both hyper- or hypothyroidism. Left ventricular systolic function is minimally decreased with slightly reduced ejection fraction and stroke volume due to thyroid levels and dilated cardiomyopathy can be a rare presentation of hyper/hypothyroidism.
History of anaemia Low hemoglobin levels are associated with worsening heart failure and cardiac dysfunction. Therefore it is important to know about patients history of anaemia. History of anaemia
Low hemoglobin levels are associated with worsening heart failure and cardiac dysfunction. Therefore it is important to know about patients history of anaemia.
Alcohol intake, Chronic alcohol abuse is
one of the most important adult causes of this disease in developed countries.
therefore it is important to know about alcohol consumption of the patient. ,
Alcohol intake,
Chronic alcohol abuse is
one of the most important adult causes of this disease in developed countries.
therefore it is important to know about alcohol consumption of the patient. ,

Clinicals - Examination

Fact Explanation
Tachypnoea In dilated cardiomyopathy due to the dilation of the left ventricle there is a systolic dysfunction and respiratory gas exchange is impaired. In order to maintain adequate perfusion as an adaption respiratory rate increases., Tachypnoea
In dilated cardiomyopathy due to the dilation of the left ventricle there is a systolic dysfunction and respiratory gas exchange is impaired. In order to maintain adequate perfusion as an adaption respiratory rate increases.,
Tachycardia Due to the dilation of the heart adequate stroke volume can not be maintained. Therefore to maintain the adequate cardiac output heart rate has to be increased. Other than that tachyarrhythmias due to the disruption of normal architecture of the cardiac muscle also cause tachycardia., Tachycardia
Due to the dilation of the heart adequate stroke volume can not be maintained. Therefore to maintain the adequate cardiac output heart rate has to be increased. Other than that tachyarrhythmias due to the disruption of normal architecture of the cardiac muscle also cause tachycardia.,
Hypertension Decrease in the cardiac output causes impaired tissue perfusion, which causes activation of neurohormonal mechanisms as RAAS(Renin angiotensin activation system). That will lead to the sympathetic activation and sodium and water retention. Hypertension
Decrease in the cardiac output causes impaired tissue perfusion, which causes activation of neurohormonal mechanisms as RAAS(Renin angiotensin activation system). That will lead to the sympathetic activation and sodium and water retention.
Elevated jugular venous pressure External or internal jugular vein may be useful in the assessment of mean venous pressure and pulse contour. In dilated cardiomyopathy due to the volume overload jugular venous pressure gets elevated. Elevated jugular venous pressure
External or internal jugular vein may be useful in the assessment of mean venous pressure and pulse contour. In dilated cardiomyopathy due to the volume overload jugular venous pressure gets elevated.
Ascites Left ventricular dilation in this disease will lead to the right heart failure and volume overload due to the neurohormonal and other compensatory mechanisms. Ascites
Left ventricular dilation in this disease will lead to the right heart failure and volume overload due to the neurohormonal and other compensatory mechanisms.
Peripheral edema When heart fails to maintain cardiac output and peripheral tissue perfusion there is expansion of extracellular fluid volume secondary to the salt and water retention. Peripheral edema
When heart fails to maintain cardiac output and peripheral tissue perfusion there is expansion of extracellular fluid volume secondary to the salt and water retention.
Shifting of the cardiac apex Due to the dilation of the left ventricle apex of the heart is deviated to the left. Shifting of the cardiac apex
Due to the dilation of the left ventricle apex of the heart is deviated to the left.
Parasternal heave Occurs due to the right ventricular hypertrophy and pulmonary hypertension which is caused by prolong dysfunction of the dilated left ventricle. Parasternal heave
Occurs due to the right ventricular hypertrophy and pulmonary hypertension which is caused by prolong dysfunction of the dilated left ventricle.
Paradoxical splitting of the s2 In this splitting of s2 occurs in expiration and pulmonary valve close before the aortic valve Paradoxical splitting of the s2
In this splitting of s2 occurs in expiration and pulmonary valve close before the aortic valve
s3, s4 s3 - Best heard at the apex, occurs due to the left ventricular dysfunction s4 - Left sided s4 which is often palpable is due to impaired left ventricular relaxation. Rarely right side s4 occurs in right ventricular dysfunction. s3, s4
s3 - Best heard at the apex, occurs due to the left ventricular dysfunction s4 - Left sided s4 which is often palpable is due to impaired left ventricular relaxation. Rarely right side s4 occurs in right ventricular dysfunction.
Murmur Murmur occur due to the functional mitral regurgitation because of the dilatation of mitral annulus and to retraction of the leaflets by chordae and papillary muscles as the left ventricle dilates.
Murmur - pan systolic murmur, best heard at the apex with radiating to the axilla.
Murmur
Murmur occur due to the functional mitral regurgitation because of the dilatation of mitral annulus and to retraction of the leaflets by chordae and papillary muscles as the left ventricle dilates.
Murmur - pan systolic murmur, best heard at the apex with radiating to the axilla.

Investigations - Diagnosis

Fact Explanation
Echocardiography(Echo) Left ventricular dilation and systolic dysfunction (depressed ejection fraction or shortening fraction), with or without mitral regurgitation can be identified by echo.It also helps to exclude other differential diagnosis. Echocardiography(Echo)
Left ventricular dilation and systolic dysfunction (depressed ejection fraction or shortening fraction), with or without mitral regurgitation can be identified by echo.It also helps to exclude other differential diagnosis.
Electrcardiography (ECG) By doing a ECG the following can be identified: sinus tachycardia, ST-T wave changes, Q waves,
conduction disease, bundle-branch block, left ventricular
hypertrophy, or ectopy, including supra-ventricular
tachycardia, atrial fibrillation, or ventricular arrhythmia. ,
Electrcardiography (ECG)
By doing a ECG the following can be identified: sinus tachycardia, ST-T wave changes, Q waves,
conduction disease, bundle-branch block, left ventricular
hypertrophy, or ectopy, including supra-ventricular
tachycardia, atrial fibrillation, or ventricular arrhythmia. ,
Chest radiography CXR shows cardiomegaly and
increased pulmonary vascular markings that are
consistent with pulmonary oedema.
Chest radiography
CXR shows cardiomegaly and
increased pulmonary vascular markings that are
consistent with pulmonary oedema.
Genetic testing It is disease which can be transmitted as autosomal (dominant and recessive), X-linked, or mitochondrial traits. Therefore genetic testing useful in diagnosis . Genetic testing
It is disease which can be transmitted as autosomal (dominant and recessive), X-linked, or mitochondrial traits. Therefore genetic testing useful in diagnosis .
Serological testing To identify infective causes as viral, bacterial, fungal, parasitic, rickettsial, and spirotrichea infections Serological testing
To identify infective causes as viral, bacterial, fungal, parasitic, rickettsial, and spirotrichea infections

Investigations - Management

Fact Explanation
Echocardiography This is important to evaluate the treatment by assessing cardiac function Echocardiography
This is important to evaluate the treatment by assessing cardiac function
Biomarkers Most widely used is BNP (B-type natriuretic peptide). It is used to monitor the presence and severity of fluid overload Biomarkers
Most widely used is BNP (B-type natriuretic peptide). It is used to monitor the presence and severity of fluid overload
Histology It is useful to distinguish between disease processes that need alternative treatment strategies and identify the cause for dilated cardiomyopathy, such as storage diseases, malignancies, sarcoidosis, and haemochromatosis , especially in secondary cardiomyopathies. Histology
It is useful to distinguish between disease processes that need alternative treatment strategies and identify the cause for dilated cardiomyopathy, such as storage diseases, malignancies, sarcoidosis, and haemochromatosis , especially in secondary cardiomyopathies.
Echocardiography This is important to assess ejection fraction and cardiac function. Echocardiography
This is important to assess ejection fraction and cardiac function.
Cardiac MRI This is important in identifying cardiac fibrosis and to predict arrhythmias Cardiac MRI
This is important in identifying cardiac fibrosis and to predict arrhythmias
Genetic testing Screening evaluations for patients at risk for inheriting dilated cardiomyopathy has fostered early interventions that both reduce symptoms and decrease the morbidity and mortality associated with arrhythmias or thromboembolic events. Genetic testing
Screening evaluations for patients at risk for inheriting dilated cardiomyopathy has fostered early interventions that both reduce symptoms and decrease the morbidity and mortality associated with arrhythmias or thromboembolic events.

Management - Supportive

Fact Explanation
Blood pressure control This can be achieved by controlling salt intake and prescribing appropriate anti hypertensives. , Blood pressure control
This can be achieved by controlling salt intake and prescribing appropriate anti hypertensives. ,
Management of thyroid disorders There are 3 frequently used therapies: antithyroid medications, thyroidectomy, and radioactive Iodine treatment. According to the patient's status management may differ. Management of thyroid disorders
There are 3 frequently used therapies: antithyroid medications, thyroidectomy, and radioactive Iodine treatment. According to the patient's status management may differ.
Control alcohol consumption With reduction of alcohol consumption oxidative stress caused by alcohol is reduced. Control alcohol consumption
With reduction of alcohol consumption oxidative stress caused by alcohol is reduced.
Anemia management Anemia can be managed with dietary modification and other medical management such as iron supplementation and erythropoietin. Anemia management
Anemia can be managed with dietary modification and other medical management such as iron supplementation and erythropoietin.

Management - Specific

Fact Explanation
Medical management Medical therapy remains the mainstay of treatment in patients with dilated cardiomyopathy and heart failure. Inhibition of angiotensin - converting enzymes and β-blockade with or without diuretics continue to be standard options. Medical management
Medical therapy remains the mainstay of treatment in patients with dilated cardiomyopathy and heart failure. Inhibition of angiotensin - converting enzymes and β-blockade with or without diuretics continue to be standard options.
Use of implantable cardioverter- defibrillators For patients with left ventricular ejection fraction of <30% and symptomatic heart failure for which they are receiving
optimum medical therapy are indicated for this.
Use of implantable cardioverter- defibrillators
For patients with left ventricular ejection fraction of <30% and symptomatic heart failure for which they are receiving
optimum medical therapy are indicated for this.
Cardiac resynchronisation Use in patients with advanced heart failure and ventricular conduction delay. This therapy is designed to eliminate the delay in activation of the left ventricular free wall, a finding often seen in adults with left ventricular systolic
dysfunction.
Cardiac resynchronisation
Use in patients with advanced heart failure and ventricular conduction delay. This therapy is designed to eliminate the delay in activation of the left ventricular free wall, a finding often seen in adults with left ventricular systolic
dysfunction.
Surgical management The goal is to improve the biophysics of the left ventricle and reduce the
stimulus for unfavorable remodeling.
- The Batista procedure, or partial left ventriculectomy, is used in patients with end stage dilated cardiomyopathy.
- Surgical ventricular restoration by recreation of the elliptical shape of the left ventricle by volume reduction
with a sizing balloon.,
Surgical management
The goal is to improve the biophysics of the left ventricle and reduce the
stimulus for unfavorable remodeling.
- The Batista procedure, or partial left ventriculectomy, is used in patients with end stage dilated cardiomyopathy.
- Surgical ventricular restoration by recreation of the elliptical shape of the left ventricle by volume reduction
with a sizing balloon.,
cardiac transplant Important in extreme cases. Waiting times for organs remain a significant restriction cardiac transplant
Important in extreme cases. Waiting times for organs remain a significant restriction
Stem cell therapy Used in end stage cases but still of questionable value., Stem cell therapy
Used in end stage cases but still of questionable value.,

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