DILATED CARDIOMYOPATHY

Dilated cardiomyopathy is characterized by dilatation and impaired ventricular contraction (LV dysfunction) leading to progressive left-sided and later, right-sided failure. Functional mitral and/or tricuspid regurgitation may occur. Arrhythmias are common. The cause cannot be identified in most of the patients; myocarditis and chronic alcohol abuse are probably frequent causes of dilated cardiomyopathy.

Causes

Idiopathic (most common).

Alcohol

Viral myocarditis

Familial and genetic factors

Peripartum cardiomyopathy

Diabetes mellitus

Sarcoidosis

Hemochromatosis

Clinical features

Features of cardiac failure, arrhythmias, or emboli.

Cardiac failure, S3 gallop rhythm.

Ventricular dilatation leads to functional mitral or tricuspid valvular regurgitation and hence murmurs associated with these conditions can be heard

Investigations

X-ray chest shows ’large flask-shaped heart (massive cardiomegaly).

Echocardiography reveals dilatation of the left ventricle, dilatation of the right ventricle with poor global contraction. It helps in the assessment of the degree of left ventricular function, and exclusion of concomitant valvular or pericardial disease.

ECG shows tachycardia, conduction abnormalities, ST-segment, and T wave changes, ventricular ectopics.

Cardiac catheterization shows left ventricular dilatation and dysfunction, high end-diastolic pressure, low cardiac output.

Treatment

Management of cardiac failure and arrhythmia

Prolonged bed rest and

Avoidance of alcohol