Dilated Cardiomyopathy Flashcards
ESSENCE
Cardiomyopathy characterised by cardiac chamber dilation and systolic dysfunction
EPIDEMIOLOGY
What is most common kind of cardiomyopathy
Dilated cardiomyopathy (90%)
AETIOLOGY
Causes
- Stress
- Takutsubo cardiomyopathy (broken heart syndrome)
- Toxins
- Alcohol
- Cocaine
- Cobalt
- Duxorubicin
- Infectious
- Coxsacki B viral myocarditis
- Chagas disease
- Hereditary
- Muscular dystrophies
- Familial
- Sarcoidosis
- Haemochromatosis
AETIOLOGY
Infectious causes
Coxsacki B viral myocarditis
Chagas disease
PATHOGENESIS
Dilated cardiac chambers causes decreased contractility and decreased ejection fraction leading to systolic dysfunction
PROGNOSIS
Death
50% within 2 years from heart failure or arrhythmia
CLINICAL FEATURES
Symptoms
- Progressive heart failure
- Dyspnoea on exertion
- Orthopnea
- Paroxysmal nocturnal dyspnea
- Fatigue
- Pulmonary oedema
CLINICAL FEATURES
Signs
- Cardiac
- S3 sound
- Systolic regurgitant murmur
- Ascites
- Jugular venous distension
- Pulmonary rales
INVESTIGATIONS
Imaging
- Radiography - all patients
- ECHO - all patients, assess ejection fraction
Radiography findings
- Heart looks like balloon
ECHO findings
- Dilated ventricles
- Reduced ejection fraction
INVESTIGATIONS
Studies
ECG
ECG findings
- May have bundle branch block
- May have widened QRS complex
INVESTIGATIONS
Making diagnosis
Based on clinical presentation and ECHO
MANAGEMENT
Approach
- Drugs that lover mortality
- Angiotensin converting enzyme inhibitors or angiotensin receptor blockers
- B-blockers
- Spironolactone or eplernone
MANAGEMENT
Conservative options
Cessation of alcohol
MANAGEMENT
Medical options
- Indication - for all patients
- ACE inhibitors
- B blockers
- Spironolactone
Most used beta blockers to reduce mortality
- Metoprolol
- Carvedilol
- Bisoprolol
MANAGEMENT
Surgical options
- Automatic implantable cardioverter/defibrillator (AICD)
- Biventricular pacemaker
- Heart transplant
Indication for AICD
Ejection fraction <35%
Indication for biventricular pacemaker
QRS > 120ms
Indication for heart transplant
Only definitive treatment
COMPLICATIONS
- Heart failure
- Thromboembolism