Dilated Cardiomyopathy

Question 1

Epidemiolgy

Answer 1

Most common cardiomyopathy generally

Question 2

Associations

Answer 2

Alcohol
Increased BP
Chemotherapeutics
Haemochromatosis
Viral infection
Autoimmune
Post partum
Thyrotoxicosis
Congenital (x-linked)

Question 3

Aetiology

Answer 3

Autosomal dominant familial (cytoskeleton gene mutation)
IHD
Alcohol

Question 4

Pathophysiology

Answer 4

Dilated flabby heart which contracts poorly and has thin muscle
Poorly generated contractile force = progressive dilation of the heart
Diffuse interstitial fibrosis
Systolic dysfunction of left or both ventricle = decreased cardiac output

Question 5

Signs

Answer 5

Increase pulse
Decrease BP
Increased JVP
Displaced and diffuse apex
S3 gallop
Mitral or tricuspid regurgitation
(Signs of HF)
- Pleural effusion
- Oedema
- Jaundice
- Hepatomegaly
- Ascites

Question 6

Symptoms

Answer 6

Fatigue
Dyspnoea
Pulmonary oedema
RVF
Emboli
A fib
Ventricular tachycardia

Question 7

Diagnosis

Answer 7

ECG - Tachycardia, non-specific t wave changes, poor r wave progression
CXR - cardiomegaly, pulmonary oedema
GOLD STANDARD = ECHO - globally dilated hypo-kinetic heart + low ejection fraction
If heart failure present = presence of BNP

Question 8

Treatment

Answer 8

Treat underlying causes
- AF (AMIODARONE, CCB, BB)
- HF (ABAL - ACE-I, BB, ALDOSTERONE ANTAGONIST = SPIRONOLACTONE, LOOP DIURETIC)