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.
