DILATED CARDIOMYOPATHY

 

Cardiomyopathy is a term that literally meaning “an ailment of the heart”, used to describe a group of diseases affecting the myocardium, which in response to injury, may undergo dilation or hypertrophy, according to Damjanov (2012),. They are a heterogeneous group of entities affecting the myocardium primarily and not associated with the major causes of cardiac disease, there is now a general agreement on a classification based upon general features of presentation and pathophysiology.  Cardiomyopathy is divided into three forms: Dilated Cardiomyopathy, Hypertrophy Cardiomyopathy, and Restrictive Cardiomyopathy.

Dilated Cardiomyopathy (90% of cases) is considered the most common cardiomyopathy (Le, Bhushan, & Grimm, 2009), also is the third most common cause of heart failure and the most frequent reason for heart transplantation.

It is considered a progressive disease of heart muscle, in which the ventricle are markedly dilated and the heart appears to have a myocardium that is either flabby or thinned and that has been partially replaced  by fibrous tissue, bringing as a  result ventricular chamber enlargement and contractile dysfunction with normal left ventricle wall thickness, the right ventricle may also be dilated (Goswami, 2014). Usually present with symptoms and signs of congestive heart failure, the initial presentation may be severe biventricular failure, accompanied by chest pain and palpitation,  (Tierney, McPhee, & Papadakis, 2005), in the physical examination we find low blood pressure, pulsus alterns, peripheral cyanosis, tachypnea, diffuse apical beat displaced inferolateral and diminished in force, irregularly irregular pulse, as mentioned by Reynolds (2013).

 

Dilated Cardiomyopathy has many causes, but finding a specific cause for an individual case may be difficult, especially as explain Goswami (2014) in patients with multiple risk factors. In many cases (50 % ) of Dilated cardiomyopathy, the cause remains unexplained or idiopathic (Reynolds, 2013). However, some idiopathic causes may result from failure to identify known causes such as infection or toxins, almost a third of cases may result from severe ethanol abuse.

Other causes include:

Genetics, secondary to other cardiovascular diseases, infections, metabolic disorders, nutritional, collagen vascular disease, infiltrative, neuromuscular diseases, primary cardiac tumor, peripartum, and immunologic conditions.

To establish the diagnosis of cardiomyopathy, we must perform a series of complementary studies such as Complete blood count, Metabolic panel, Thyroid function tests, Cardiac biomarkers, B-type natriuretic peptide assay, Chest radiography, Echocardiography, Cardiac magnetic resonance imaging (MRI), and Electrocardiography (ECG) .

As explained by Reynolds (2013) four chamber dilation, decreased global left ventricular systolic and diastolic function, increased left ventricular volumes and left ventricular mass index, with eccentric left ventricular hypertrophy and usually small pericardial effusion are general echocardiographic findings.

Finally the treatment of Dilated cardiomyopathy is essentially the same as treatment of chronic heart failure like a complex clinical syndrome for which many treatment modalities have emerged.

 

Bibliography

Damjanov, I. (2012). Pathology for the Health Professions. Missouri: ELSEVIER Saunders.

Goswami, V. J. (2014, Oct 6). Medscape. Retrieved from emedicine.medscape.com: http://emedicine.medscape.com/article/152696-overview

Le, T., Bhushan, V., & Grimm, L. (2009). FIRST AID for the USMLE step 1. USA: McGraw Hill.

medscape.com. (n.d.). Retrieved from Dilated Cardiomyphaty.

Reynolds, T. (2013). the Echocardiographer's Pocket Reference. Phoenix: Arizona Foundation.

Tierney, L. M., McPhee, S. J., & Papadakis, M. A. (2005). CURRENT Medical Diagnosis & Treatment. New York: McGraw Hill.