Dilated Cardiomyopathy

Primary (idiopathic) is a disease of unknown etiology that principally affects the myocardium leading to LV dilation and systolic dysfunction

Secondary causes include ischemia, alcoholic, peripartum, post-infectious, viral

Most common of the cardiomyopathies

Schematic of Dilated CM



DCM - Incidence and Prognosis

Prevalence is 36 per 100,000 population
Third most common cause of heart failure
Most frequent cause of heart transplantation
DCM accounts for approximately 10,000 deaths and 46,000 hospitalizations per year in the US
Complete recovery is rare
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Idiopathic Dilated Cardiomyopathy

Observed Survival of 104 Patients



Clinical Manifestations

Highest incidence in middle age
Blacks 2x more frequent than whites
Men 3x more frequent than women
Symptoms may be gradual in onset
Acute presentation
Misdiagnosed as viral URI in young adults
Uncommon to find specific myocardial disease on endomyocardial biopsY
Symptoms/Signs of heart failure
Pulmonary congestion (left heart failure) dyspnea (rest, exertional, nocturnal), orthopnea
Systemic congestion (right heart failure) edema, nausea, abdominal pain, nocturia
Low cardiac output
Hypotension, tachycardia, tachypnea
Fatigue and weakness
Arrhythmia
Atrial fibrillation, conduction delays, complex PVC’s, sudden death

Diagnostics

CXR (enlarged heart, CHF)
Electrocardiogram (tachycardia, A-V block, LBBB, NSSTT changes, PVC’s)
24-hour Holter monitor
if lightheadedness, palpitation, syncope
Echocardiogram (left ventricular dilation, global hypokinesis, low EF)
Myocardial biopsy, rare
Cardiac catheterization (R/O CAD)
if age >40, ischemic history, high risk profile, abnormal ECG

DCMP - Treatment
Limit activity based on functional status
Salt restriction
Fluid restriction
Initiate medical therapy
ACE inhibitors, diuretics
Digoxin, coreg
Hydralazine/nitrate combination
Anticoagulation prn (EF <30%,>Implantable defibrillators
Cardiac transplantation
This disorder is the most common indication for cardiac transplantation
Survival after transplant is
80% one year
70% 5 years

Left Ventricular Reduction Procedures
LV-reshaping







ABOUT AUTHOR

Elaine M. Szewc, RN, BS
Medical Underwriting Consultant
John Hancock Life Insurance-->