Dilated cardiomyopathy resident survival guide

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Steven Bellm, M.D. [2]

Dilated cardiomyopathy resident survival guide Microchapters
Overview
Causes
Diagnosis
Treatment
Do's
Dont's

Overview

Dilated cardiomyopathy (DCM) relates to a group of heterogeneous myocardial disorders and is characterized by dilatation and impaired contraction and systolic function of the left or both ventricles. Atrial and/or ventricular arrhythmias can occcur, and there is a risk for sudden death. [1] The weight of the heart is increased but the maximal thicknesses of the left ventricular free wall and septum are usually normal as a result of the abnormally dilated chambers.[2]

Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.[3]

  • Life-threatening causes:
  • Common causes:

Complete Diagnostic Approach

A complete diagnostic approach should be carried out after a focused initial rapid evaluation is conducted and following initiation of any urgent intervention.[4]

 
 
 
 
 
 
 
Symptoms of heart failure
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
History and symptpms:

❑  Hints for etiology (family history, and others) ❑  Duration and onset of illness ❑  Severity and triggers of dyspnea and fatigue, presence of chest pain, exercise capacity, physical activity, sexual activity (NYHA?) ❑  Weight loss/weight gain (cachexia/volume overload?) ❑  Palpitations/(pre)syncope/ICD shocks(adverse prognosis) ❑  Symptoms of transient ischemic attack or thromboembolism (anticoagulation necessary?) ❑  Presence of peripheral edema or ascites (volume overload?)

❑  Problems with breathing at night/ sleep ❑  Medical history:

❑  Prior hospitalizations for HF (adverse prognosis?)
❑  Discontinuation of medications (reasons?)
❑  Medications that may exacerbate HF
❑  Diet (restriction of sodium and fluid intake?)
 
 
 
 
 
 
 
 
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Treatment

shown

hidden

Do's

Dont's

References

  1. ↑ "Report of the WHO/ISFC task force on the definition and classification of cardiomyopathies". Br Heart J. 44 (6): 672–3. 1980. PMC 482464. PMID 7459150.
  2. ↑ Tazelaar HD, Billingham ME (1986). "Leukocytic infiltrates in idiopathic dilated cardiomyopathy. A source of confusion with active myocarditis". Am J Surg Pathol. 10 (6): 405–12. PMID 3521345.
  3. ↑ Felker GM, Thompson RE, Hare JM, Hruban RH, Clemetson DE, Howard DL; et al. (2000). "Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy". N Engl J Med. 342 (15): 1077–84. doi:10.1056/NEJM200004133421502. PMID 10760308.
  4. ↑ Yancy, C. W.; Jessup, M.; Bozkurt, B.; Butler, J.; Casey, D. E.; Drazner, M. H.; Fonarow, G. C.; Geraci, S. A.; Horwich, T.; Januzzi, J. L.; Johnson, M. R.; Kasper, E. K.; Levy, W. C.; Masoudi, F. A.; McBride, P. E.; McMurray, J. J. V.; Mitchell, J. E.; Peterson, P. N.; Riegel, B.; Sam, F.; Stevenson, L. W.; Tang, W. H. W.; Tsai, E. J.; Wilkoff, B. L. (2013). "2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. 128 (16): e240–e327. doi:10.1161/CIR.0b013e31829e8776. ISSN 0009-7322.
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