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Dilated cardiomyopathy

Dilated cardiomyopathy or DCM (also known as congestive cardiomyopathy), is a disease of the myocardium (the muscle of the heart) in which a portion of the myocardium is dilated, often without any obvious cause. About one in three cases of congestive heart failure (CHF) is due to dilated cardiomyopathy.1 more...

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A cardiomyopathy is any disease that primarily affects the muscle of the heart. In DCM, left and/or right ventricular systolic pump function of the heart is impaired, leading to progressive cardiac enlargement and hypertrophy, a process called remodeling.1

Dilated cardiomyopathy is the most common form of cardiomyopathy. It occurs more frequently in men than in women, and is most common between the ages of 20 and 60 years.2

Etiology

Although no cause is apparent in many cases, dilated cardiomyopathy is probably the end result of myocardial damage produced by a variety of toxic, metabolic, or infectious agents. It may be the late sequel of acute viral myocarditis, possibly mediated through an immunologic mechanism. Alcohol abuse is also strongly associted with the development of dilated cardiomyopthy in some cases. Autoimmune mechanisms are also suggested as a cause for dilated cardiomyopathy.3

A reversible form of dilated cardiomyopahty may be found with alcohol abuse, pregnancy, thyroid disease, cocaine use, and chronic uncontrolled tachycardia.

Genetics

About 20-40% of patients have familial forms of the disease, with mutations of genes encoding cytoskeletal, contractile, or other proteins present in myocardial cells.4 The disease is genetically heterogenous, but the most common form of its transmission is an autosomal dominant pattern. Autosomal recessive, X-linked, and mitochondrial inheritance of the disease is also found.5

Althought the disease is more common in African-Americans than in whites, it may occur in any patient population.

Associated symptoms

Symptoms of left- and right-sided congestive heart failure develop gradually in most patients. Left ventricualr dilatation may be present for months or even years before the patient becomes symptomatic.

Vague chest pain may be present, but typical angina pectoris is unusual and suggests the presence of concomitant ischemic heart disease. Syncope due to arrhythmias, and systemic embolism may occur.

Physical examination

The patients may present variable degrees of cardiac enlargement, and findings of congestive heart failure. In advance stages of the disease, the pulse pressure is narrowed and the jugular venous pressure is elevated. Third and fourth heart sounds are common. Mitral or tricuspid regurgitation may occur, presented by systolic murmurs upon auscultation (see mitral regurgitation and tricuspid insufficiency for more details about the findings).

Laboratory examinations

Generalized enlargement of the heart is seen upon normal chest X-ray. Pleural effusion may also be noticed, which is due to pulmonary venous hypertension.

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Advances in Cardiomyopathies : Proceedings of the II Florence Meeting on Advances on Cardiomyopathies April 24-26, 1997 $114.99 Chronic Viral and Inflammatory Cardiomyopathy (Ernst Schering Research Foundation Workshop) $74.95
DEFINITE results favor Prophylactic ICD use in Nonischemic dilated cardiomyopathy.(Defibrill ators in Nonischemic Cardiomyopathy Treatment Evaluation, Implantable ... : An article from: Internal Medicine News $5.95 The Official Patient's Sourcebook on Dilated Cardiomyopathy $21.21
Dilated Cardiomyopathy - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References $48.95 ICDs suitable in nonischemic heart disease: first primary prevention trial. (implantable cardioverter defibrillators).(Clinical Rounds) : An article from: Family Practice News $5.95
The Official Patient's Sourcebook on Dilated Cardiomyopathy: A Revised and Updated Directory for the Internet Age $24.95 Cardiac sympathetic activity estimated by 123I-MIBG myocardial imaging in patients with dilated cardiomyopathy after (beta)-blocker or angiotensin-converting ... from: The Journal of Nuclear Medicine $20.00
Cardiomyopathies in adolescents: Dilated, hypertrophic, and restrictive : An article from: Adolescent Medicine $20.00 Efficacy of carvedilol treatment on cardiac function and cardiac sympathetic nerve activity in patients with dilated cardiomyopathy: Comparison with metoprolol ... from: The Journal of Nuclear Medicine $20.00

Left atrial functional reserve in patients with nonischemic dilated cardiomyopathy : an echocardiographic dobutamine study - clinical investigations
Objective: To evaluate left atrial functional reserve in patients with chronic heart failure and nonischemic dilated cardiomyopathy (DCM). Background: ...
Dobutamine gated blood pool scintigraphy predicts the improvement of cardiac sympathetic nerve activity, cardiac function, and symptoms after treatment
Background: We evaluated whether dobutamine gated blood pool scintigraphy (DOB-GBP) can predict improvement in cardiac sympathetic nerve activity and ...
Managing life threatening viral myocarditis with dilated cardiomyopathy by Drotrecogin alfa and circulatory assisted devices
PURPOSE: Acute fulminant myocarditis with dilated cardiomyopathy caused by Parvovirus B19 may present with cardiogenic shock refractory to the maximum ...
Myocardial apoptotic index based on in situ DNA nick end-labeling of endomyocardial biopsies does not predict prognosis of dilated cardiomyopathy
Background: DNA breaks detected largely by terminal deoxynucleotidyltransferase-mediated deoxyuridine triphosphate in situ nick end-labeling (TUNEL) ...
Assessment of prognosis in idiopathic dilated cardiomyopathy - Editorial
Determining the prognosis in each patient with idiopathic dilated cardiomyopathy (IDC) has been an important goal since the introduction of cardiac transplantation. Although heart transplants conti
Prognostic value of low-dose dobutamine echocardiography in patients with idiopathic dilated cardiomyopathy
Study objectives: Dobutamine echocardiography is widely used for the evaluation of myocardial contractile reserve. The purpose of the study was to determine ...
Reversibility of coronary endothelial vasomotor dysfunction in idiopathic dilated cardiomyopathy: acute effects of vitamin C - Abstracts
In patients with idiopathic dilated cardiomyopathy, endothelium vasomotor function is disturbed. Increased oxidative stress and the consecutive formation ...
The effect of coenzyme Q10 on idiopathic chronic dilated cardiomyopathy in children
Soongswang J, Sangtawesin C, Durongpisitkul K, et al. Pediatr Cardiol 2005 Jan 27: [Epub ahead of print]. The objective of this study was to assess ...

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