Dilated Cardiomyopathy - Causes - Symptoms - Signs - Diagnosis - Treatment

Dilated Cardiomyopathy

Dilated Cardiomyopathy (DCM) is characterized by dilation of ventricles and impairment in the contractility of heart muscles. One-fifth to one-third of patients may be genetic.


Causes are numerous:

• Cardiovascular Disorders
• Systemic hypertension
• Ischemic heart disease
• Disease of the heart valves
• Myocarditis (Inflammation of the myocardium)
• Peripartum Cardiomyopathy
• Toxins
• Alcohol
• Radiation
• Cocaine
• Infections,
• Metabolic,
• Neuromuscular,
• Inflammatory disorders -Rheumatoid arthritis
• Autoimmune - Systemic lupus erythematosus

Symptoms & Signs

A gradual decrease in exercise capacity is the classical presentation. This is however a retrospective entity. A condition like anemia, thyrotoxicosis, or infection may trigger this acute decline in exercise capacity.

• About one in three cases of congestive heart failure is due to dilated Cardiomyopathy.
• Chest pain may be prominent
• Different forms of breathlessness like orthopnea (breathlessness in the lying down position), and paroxysmal nocturnal dyspnea (Here the patient awakens from sleep with acute, severe shortness of breath after 1 to 3 hours of sleep).
• Nocturnal cough
• Peripheral oedema

Diagnosis

The diagnosis of dilated Cardiomyopathy is usually based on the recognition of signs or symptoms of heart failure. A detailed physical examination, 12-lead ECG tracings, and two-dimensional echocardiography study help to confirm the diagnosis.

Coronary Angiography is required in some cases.


Other recommended tests include:

• A complete blood count
• Functions of the kidney, liver, and thyroid
• Chest X-ray

Treatment

Heart failure is a medical emergency requiring intelligent intervention. Supportive therapies include:

• Sodium and fluid restriction
• Avoidance of alcohol and other toxins
• Heart failure medications
• Complications like atrial fibrillation may require anticoagulants

Rest and avoidance of exercise are recommended for a few conditions unlike in the past.

The prognosis of dilated Cardiomyopathy is related to the severity of disease at the time of presentation and the response to initial treatment. Improvement with treatment occurs in most cases.

References:

1. Cecil Medicine, 23rd Ed.
2. Harrison's PRINCIPLES OF INTERNAL MEDICINE, 17^TH Edition
3. Garlic Oil may Protect Against Cardiomyopathy in Diabetes Patients - (http://www.medindia.net/news/Garlic-Oil-may-Protect-Against-Cardiomyopathy-in-Diabetes-Patients-74723-1.htm)
4. Link between enteroviruses and dilated cardiomyopathy: serological and molecular data - (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1025673/)

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