Dilated cardiomyopathy

Background

Schematic showing dilated cardiomyopathy compared to a normal heart.

Dialated cardiomyopathy on pathology. Opened left ventricle of heart shows a thickened, dilated left ventricle with subendocardial fibrosis manifested as increased whiteness of endocardium.

• Heart is dilated with poor contraction and EF

Causes

• Idiopathic (25% of CHF)
• Viral/chronic myocarditis (most common identifiable cause)
• Other causes
  • Ischemic
  • Other infectious - HIV, Lyme, Chagas
  • Familial dilated cardiomyopathy
  • Hypertensive dilated cardiomyopathy
  • Toxic (ETOH/beriberi, cocaine, methamphetamine, chemo, heavy metals)
  • Hyperthyroidism
  • Sarcoidosis
  • Peripartum cardiomyopathy
  • Kawasaki disease
  • Autoimmune, SLE
  • Connective tissue disease
  • Infiltrative disease
  • Mitochondrial disease
  • Tachycardia-mediated
  • ESRD
  • Eosinophilic (Churg-Strauss syndrome)

Clinical Features

• CHF symptoms

Differential Diagnosis

Cardiomyopathy

• Dilated cardiomyopathy
• Hypertrophic cardiomyopathy
• Restrictive cardiomyopathy
• Peripartum cardiomyopathy
• Takotsubo cardiomyopathy
• Arrhythmogenic right ventricular dysplasia

Evaluation

ECGs of a patient with cardiomyopathy: LBBB accompanied by right access deviation (about 108°) and left atrial enlargement.

18 year old with dilated cardiomyopathy (pacemaker in place).

Dialated cardiomyopathy on CT.

Workup

• CXR
  • Cardiomegaly, pulmonary venous htn
• ECG
  • LV hypertrophy, poor R wave progression
• Ultrasound
  • Bedside (for gross function)
  • TTE/TEE for EF

Diagnosis

• Typically on cardiac ultrasound (echo)

Management

• Treat the underlying disease
• Similar to CHF exacerbation
• Ensure exacerbation not due to ischemia

Disposition

• Admit for new diagnosis

See Also

• Cardiomyopathy (Main)