Dilated Cardiomyopathy

Dilated cardiomyopathy (DCM) is myocardial dysfunction, which causes a failure with ventricular dilatation and leading systolic dysfunction. Symptoms include dyspnea, fatigue and peripheral edema. The diagnosis is made clinically because of the X-ray image of the natriuretic peptides, echocardiography and MRI. The treatment depends on the particular cause. If the heart failure is progressive and difficult, cardiac resynchronization therapy, an implantable cardioverter defibrillator, a repair moderate to severe valve insufficiency or a heart transplant may be necessary.

Dilated cardiomyopathy (DCM) is myocardial dysfunction, which causes a failure with ventricular dilatation and leading systolic dysfunction. Symptoms include dyspnea, fatigue and peripheral edema. The diagnosis is made clinically because of the X-ray image of the natriuretic peptides, echocardiography and MRI. The treatment depends on the particular cause. If the heart failure is progressive and difficult, cardiac resynchronization therapy, an implantable cardioverter defibrillator, a repair moderate to severe valve insufficiency or a heart transplant may be necessary. Pathophysiology In some patients it is assumed that the DCM with acute myocarditis begins (probably most of viral origin), followed by a different long latent phase, a phase with diffuse necrosis of cardiomyocytes (due to an autoimmune response to virally modified myocytes) and chronic fibrosis , Whatever the cause of dilated the myocardium, thins out and hypertrophied compensatory (s. Forms of cardiomyopathy), which often leads to a functional mitral or tricuspid valve insufficiency, and atrial magnification. The disease affects both ventricles in most patients, with few even the LV (unless the cause ischemia), and rarely the RV. Often mural thrombi form as soon as the chamber dilation is significant, particularly in the phase of acute myocarditis. Cardiac arrhythmias and AV block often complicate the acute myocarditis and the late phase of dilation. Atrial fibrillation occurs frequently when the left atrium is dilated. Etiology DCM has many known and probably many unidentified causes (s. Causes of dilated cardiomyopathy). The most common reason in temperate climates is the diffuse coronary artery disease (CAD) with diffuse ischemic cardiomyopathy. More than 20 viruses can cause DCM; in temperate climates the Coxsackie B virus is the most common viral cause. In Central and South America, the Chagas’ disease is due to infection with Trypanosoma cruzi the most common infectious cause. The DCM is increasingly diagnosed more frequently in patients with HIV infection. Other causes include toxoplasmosis, thyrotoxicosis and beriberi. Many toxic substances v. a. Alcohol, various organic solvents and certain chemotherapeutic agents (e.g., doxorubicin, trastuzumab), damage the heart. Sudden emotional stress and other hyperadrenerge states can trigger acute DCM, which is typically reversible (as is the DCM caused by long periods of tachycardia). One example is the acute “apical ballooning” (Takotsubo cardiomyopathy). In this disease, the tip of the LV and occasionally other areas is usually affected, resulting in regional wall dysfunction and sometimes focal dilation (ballooning). Genetic factors play a role in 20-35% of cases; far more genes and gene segments have been implicated. Causes of dilated cardiomyopathy caused samples (acute or chronic) Bacterially-associated spirochetes rickettsia-associated viral (including HIV infection) Fungal unicellular by parasitic worms causes chronic diffuse myocardial ischemia Chronic coronary heart disease Uncontrolled tachycardia atrial fibrillation or other tachyarrhythmias persistent infections Granulomatous diseases sarcoidosis granulomatous or giant cell granulomatous myocarditis with polyangiitis (Wegener’s granulomatosis), metabolic disorders nutritional disorders (eg. B. beriberi, selenium deficiency, carnitine deficiency, kwashiorkor) Hereditary storage diseases uremia hypokalemia hypomagnesemia hypophosphatemia diabetes mellitus hyperthyroidism hypothyroidism pheochromocytomas acromegaly Morbid obesity drugs and toxins ethanol cocaine anthracyclines cobalt psychotropic drugs (tricyclic and tetracyclic antidepressants, phenothiazine) catecholamines cyclophosphamide Herceptin radiation tumors Certain endocrinologically active tumors (z. B. pheochromocytoma, tumors of the adrenal and thyroid glands) connective tissue diseases SLE Systemic sclerosis RA genetic anomaly In 20-30% of patients familial disease: autosomal dominant, X-linked, autosomal recessive or mitochondrial inheritance Hereditary neuromuscular and neurological disorders Friedreich’s ataxia pregnancy (peripartum period) – Symptoms and signs Except for acute myocarditis, acute apical Ballo discrimination and tachyarrhythmia-induced myopathy is a disease gradually. The symptoms depend on which ventricle is affected. An LV dysfunction caused dyspnea and fatigue on exertion due to an increased diastolic pressure and a lower cardiac output. An RV insufficiency caused peripheral edema and a neck venous stasis. Rarely the RV is affected especially in younger patients; then atrial arrhythmia and sudden death due to malignant ventricular tachyarrhythmias are typical. Approximately 25% of patients with DCM have atypical chest pain. Diagnostic chest X-ray ECG echocardiography tests set to causes if indicated Diagnosis is based on history, physical examination and by excluding other common causes of Ventrikeleinschränkung (z. B. systemic hypertension, primary valvular disease, myocardial infarction diagnosis and treatment of cardiomyopathies). Therefore, an EKG, chest X-ray, echocardiography and more recently cardiac MRI are needed. If acute symptoms or chest pain are present, the cardiac enzymes are measured in the serum; although the troponin typically display a coronary ischemia, they are often elevated in heart failure, v. a. when renal function is impaired. The levels of natriuretic peptide i. S. are typically increased when heart failure is present. Clinically suspected specific causes are diagnosed (see elsewhere in the MSD Manual). If no specific cause is present from a clinical perspective, serum ferritin, iron binding capacity and TSH levels are determined in appropriate cases. Serological tests for Toxoplasma, T. cruzi, coxsackievirus and echovirus can be carried out in appropriate cases. The chest x-ray image usually shows cardiomegaly all heart chambers. A pleural effusion, especially the right, often accompanied the increased pulmonary venous pressure and interstitial edema. Dilated cardiomyopathy (chest x-ray) © Springer Science + Business Media var model = {thumbnailUrl: ‘/-/media/manual/professional/images/523-dilated-cardiomyopathy-chest-x-ray-s116-springer-high_de.jpg?la = en & thn = 0 & mw = 350 ‘, imageUrl:’ /-/media/manual/professional/images/523-dilated-cardiomyopathy-chest-x-ray-s116-springer-high_de.jpg?la=de&thn=0 ‘, title : ‘dilated cardiomyopathy (chest x-ray) “, description:’ u003Ca id = ” v37893629 “”class = “” anchor “” u003e u003c / a u003e u003cdiv class = “” para “” u003e u003cp u003eDiese x-ray shows severe cardiomegaly in a patient with dilated cardiomyopathy u003c / p u003e u003c / div u003e ‘credits’. © Springer Science + Business Media’

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