Prasad, md abstract dilated cardiomyopathy dcm is best understood as the. A 69yearold man with a history of a dilated cardiomyopathy presents with several hours of palpitations and sudden onset of shortness of breath. Depending on your symptoms, you might need two or more of these drugs. Dilated cardiomyopathy is a heart muscle disorder defined by the presence of a dilated and poorly functioning left ventricle in the absence of abnormal loading conditions hypertension, valve disease or ischaemic heart disease sufficient to cause global systolic impairment. A significant proportion of dcm cases have an underlying genetic or. The diagnostic work up of genetic and inflammatory dilated.
Download this factsheet as a pdf the aim of this information sheet is to explain what dilated cardiomyopathy is, what effect it will have on a child and how it can be treated what is dilated cardiomyopathy. It occurs more frequently in men than in women, and is most common between the ages of 20 and 60 years. Complications can include heart failure, heart valve disease, or an irregular heartbeat. Voiceover lets talk about the pathophysiology and diagnosis of dilated cardiomyopathy. The diagnosis and evaluation of dilated cardiomyopathy. Dilated cardiomyopathy dcm characterised by ventricular dilatation. The diagnosis and evaluation of dilated cardiomyopathy jacc. Dilated cardiomyopathy dcm is a primary myocardial disease characterized by varying degrees of left ventricular lv dysfunction and dilatation in the absence of chronic increased afterload e. More than 20 viruses can cause dilated cardiomyopathy. About one in three cases of congestive heart failure chf is due to dilated cardiomyopathy. Dcm is a condition where the heart chambers become enlarged, which affects its ability to pump.
Ecg changes seen in left ventricular hypertrophy lvh and right ventricular hypertrophy rvh. Dilated cardiomyopathy dcm is a disease of the heart muscle which primarily affects the hearts main pumping chamber, the left ventricle. Racgp hypertrophic cardiomyopathy in the adolescent. Ecg reference sites and books the best of the rest. Dilated cardiomyopathy dcm most prominent cm incidence 36 cases100,000 per year diagnostic criteria are lacking males and africans middle age idcm accounts for 25% of all heart failure cases. Dilated cardiomyopathy is defined by the presence of left ventricular dilatation and contractile dysfunction. A rigorous workup can exclude alternative causes of left ventricular lv dilation and dysfunction, identify etiologies that may respond to specific treatments, and guide family screening. By definition, coronary arteries are normal in dcm. It is the most common type of cardiomyopathy and typically affects those aged 20 to 60. Hypertrophic cardiomyopathy for patients, their families and interested physician.
Dilated cardiomyopathy affects the hearts ventricles ventrihkuls and atria aytreeuh. Table 1 summarises a list of abnormal ecg findings unrelated to athletic. So almost everyone with dilated cardiomyopathy will have an abnormal but its going to be nonspecific. Secondary stt changes in left sided leads left ventricular hypertrophy is often accompanied by j point depression, downsloping st segment and inverted asymmetric twaves i the.
Ecg characteristics of dilated cardiomyopathy sciencedirect. In central and south america, chagas disease due to trypanosoma cruzi is the most common infectious cause. Dilated cardiomyopathy is the third most common cause of heart failure and the most frequent reason for heart transplantation. In addition, serial ecg and echocardiographic changes in dcm during a mean followup period of 1. Ecg az by diagnosis litfl ecg library clinical interpretation. Persons with cardiomyopathy frequently retain excess fluid, resulting in congestion of the lungs, and have. The heart muscle is weakened, making it more difficult for blood to flow from the body and lungs into the heart and for blood to be pumped from the heart to the rest of the body. Signs and symptoms of dcm dilated cardiomyopathy can appear along a spectrum of no symptoms, subtle symptoms or, in the more severe cases. A large number of cardiac and systemic diseases can cause systolic impairment and left ventricular dilatation, but in. Dilated cardiomyopathy can be familial genetic, and it is estimated that 2030% of children with dcm have a relative with the disease, although they may not have been diagnosed or have symptoms. Dilated cardiomyopathy heart cardiovascular system.
The ecg criteria to diagnose hypertrophic obstructive cardiomyopathy hocm including the apical variant is discussed with example 12lead ecgs. Dilated cardiomyopathy dcm is a condition in which the heart becomes enlarged and cannot pump blood effectively. Dilated cardiomyopathy is a disease of the heart muscle. Oct 09, 2017 echo assessment of cardiomyopathy pdf slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. However, given the retrospective nature and the small size of the present study, our findings should be considered preliminary, and should. Diagnosis and management of dilated x cardiomyopathy. Dilated means enlarged, cardio concerns the heart and a.
Complications can include heart failure, heart valve disease, or an irregular heartbeat causes include genetics, alcohol, cocaine, certain toxins. The cardiomyopathy is considered dilated if the following criteria can be observed 1 left ventricular enddiastolic diameter lvedd 117% of the age and body surface 2 left ventricular systolic dysfunction lvsd defined by left ventricular ejection fraction lvef dilated cardiomyopathy dcm is a condition in which the heart becomes enlarged and cannot pump blood effectively. At post mortem, other criteria should actively excluded, such as myocardial infarction, other coronary vascular disease, myocarditis etc. An abnormal ekg doesnt necessarily say someone has dilated cardiomyopathy.
Cardiomyopathy is a group of diseases that affect the heart muscle. Authored by corinne bottsilverman of the cleveland clinic. Using rigorous criteria less than 15% patients of dcm patients have. A gene defect that causes conduction system disease and dilated cardiomyopathy maps to chromosome. Dilated cardiomyopathy is a condition in which the heart muscle becomes weakened and enlarged. Dilated cardiomyopathy cardiovascular disorders merck. Dilated cardiomyopathy has many known and probably many unidentified causes see table causes of dilated cardiomyopathy.
Overview of electrocardiogram diagnosis as an adjunct to litfl ekg library. Proposal for a revised definition of dilated cardiomyopathy, hypokinetic nondilated cardiomyopathy, and its implications for clinical practice. Left bundle branch block diagnosing myocardial infarction sgarbossa criteria. Cardiomyopathy, any cardiac disease process that results in heart failure due to a decrease in the pumping power of the heart or due to an impairment in the filling of the cardiac chambers. Most common ecg abnormalities are associated with atrial and ventricular hypertrophy typically, left sided changes are seen but there may be signs of biatrial or biventricular hypertrophy. This book is distributed under the terms of the creative commons attribution 4. Drugs that have proved useful in the treatment of heart failure and dilated cardiomyopathy include. Hypertrophic cardiomyopathy hcm is a relatively common, inherited cardiac disease with a prevalence of one in 500 people. As a result, the heart cannot pump enough blood to the rest of the body. Abstract the term dilated cardiomyopathy dcm defines a. However, the ecg is frequently abnormal in patients with dcm. Mestroni l, maisch b, mckenna wj, schwartz k, charron p, rocco c, tesson f, richter a, wilke a, komajda m. Hypertrophic cardiomyopathy hcm is one of the most common inherited cardiac disorders affecting 1 in 500 people and is the number one cause of sudden cardiac death in young athletes. Dilated cardiomyopathy diagnosis and treatment mayo clinic.
The electrical vector of the left ventricle is enhanced in lvh, which results in large rwaves in left sided leads v5, v6, avl and i and deep swaves in right sided chest leads v1, v2. The most common causes of dilated cardiomyopathy are. Causes, signs and symptoms, pathogenesis, diagnosis, and treatment duration. Abnormal electrocardiographic findings in athletes. In the ekg of dilated cardiomyopathy its almost always abnormal but the findings are nonspecific. Echo assessment of cardiomyopathy pdf linkedin slideshare. Heart function in dilated cardiomyopathy dilated cardiomyopathy dcm is a disease of the heart muscle in which the heart chambers become enlarged or dilated.
Diagnosis is clinical and by elevated natriuretic peptides, chest xray, echocardiography, and mri. There are no ecg features unique to dcm, although the ecg is usually abnormal. Those affected are at an increased risk of sudden cardiac death. Dilated cardiomyopathy is a progressive disease of heart muscle that is characterized by ventricular chamber enlargement and contractile dysfunction. The same etiology may not only damage the myocardium. Ecg changes in left ventricular hypertrophy lvh large rwaves in left sided leads v5, v6, i and avl and deep swaves in right sided leads v1, v2 indicate the the vector of the left ventricle is amplified. Doctors usually treat dilated cardiomyopathy with a combination of medications. Diagnosis and management of dilated cardiomyopathy heart. Dilated cardiomyopathy dcm is a disease of the heart muscle. Diagnosis and evaluation of dilated cardiomyopathy american. Pdf diagnosis and assessment of dilated cardiomyopathy. Collaborative research group of the european human and capital mobility project on familial dilated cardiomyopathy.
Genetic mutations involving genes that encode cytoskeletal, sarcomere, and nuclear envelope proteins, among others, account for up to 35% of cases. Men are more likely than women to have this type of cardiomyopathy. Dilated cardiomyopathy is myocardial dysfunction causing heart failure in which ventricular dilation and systolic dysfunction predominate. To elucidate the electrocardiographic ecg characteristics of dilated cardiomyopathy dcm, the authors analyzed the 12lead ecgs and echocardiograms in 45 patients with dcm, 54 patients with left ventricular lv dilatation secondary to valvular heart disease vhd, 101 hypertensive patients with lv hypertrophy, and 63 normal control subjects. Jul 15, 2019 dilated cardiomyopathy in dilated cardiomyopathy dcm the most common type the ecg may display nonspecific features of an increased left ventricular muscle mass suggestive of left ventricular hypertrophy lvh, pathological q waves and poor r wave progression, with some abnormalities affecting the t wave and st segment. Dilated and restrictive cardiomyopathies cleveland clinic. Dilated cardiomyopathy national stroke association.
The left ventricle of the heart becomes enlarged dilated and the muscle wall becomes thinner. Attempts to correlate the surface ecg features with. If you continue browsing the site, you agree to the use of cookies on this website. Proposed guidelines for the diagnosis of canine idiopathic.
The electrocardiogram in the diagnosis and management of patients. Patients and methods study patients a total of 17 patients with dilated cardiomyopathy, and referred to one of the authors, were included in the study. Electrocardiogram ekg may show nonspecific st segment and t wave abnormalities. A significant proportion of dcm cases have an underlying. The right ventricle may also be dilated and dysfunctional. A large number of cardiac and systemic diseases can cause systo. The left ventricle of affected individuals becomes enlarged dilated and cannot pump blood to the body with as much force as a healthy heart can.
Added evaluation of patients with cardiomyopathy, or a firstdegree relative with arrhythmogenic right ventricular cardiomyopathy as an indication to the adult criteria, and expanded pediatric criteria for cardiomyopathy evaluation of patients with hypertrophic or dilated cardiomyopathy to the same as the adult cardiomyopathy criteria. Goldbergers triad is a specific ecg sign for dilated cardiomyopathy, it is not reflective of the severity of left ventricular dysfunction. It is a heterogeneous disorder, produced by mutations in multiple genes coding for sarcomeric proteins e. However, if patients manage their symptoms properly based on the necessary precautions and regular checkups as well as recommendations from doctors, they can increase to up to 10 years period. Dilated cardiomyopathy dcm is best understood as the final common response of myocardium to diverse genetic and environmental insults. Acquired causes include myocarditis and exposure to alcohol, drugs and toxins, and metabolic and endocrine disturbances. Pdf cardiomyopathies are group of disease with specifically affect the heart muscles.
Dilated left ventricle with systolic dysfunction not caused by ischaemic or valvular heart disease cardiac dilatation with systolic dysfunction 3. Cardiomyopathy, dilated cardiomyopathy, hypertrophic cardiomyopathy. As the disease worsens, shortness of breath, feeling tired, and swelling of the legs may occur, due to the onset of heart failure. Guidelines for the study of familial dilated cardiomyopathies. Frequency and phenotypes of familial dilated cardiomyopathy. Study of dilated cardiomyopathy in correlation with electrocardio.
Dilated and restrictive cardiomyopathies online medical reference covers diseases of the myocardium associated with cardiac dysfunction. Dilated cardiomyopathy heart cardiovascular system free. Dilated cardiomyopathy dcm is a disease of the heart muscle with impaired systolic function impaired contractility which involves one or both ventricles. Dilated cardiomyopathy definition of dilated cardiomyopathy. Dilated cardiomyopathy dcm is defined as left ventricular lv dilation and systolic dysfunction in the absence of coronary artery disease or abnormal loading conditions proportionate to the degree of lv impairment. An utterly normal ecg makes systolic dysfunction extremely. Dilated cardiomyopathy dcm is a myocardial disease characterised by ventricular dilatation and global myocardial dysfunction ejection fraction dilated cardiomyopathy embx endomyocardial biopsy fmr functional mitral regurgitation hf heart failure icd implantable cardioverterde.
Denise antle, arnp, msn, ccrn, ccns critical care arnpcns. Dilated cardiomyopathy in dilated cardiomyopathy dcm the most common type the ecg may display nonspecific features of an increased left ventricular muscle mass suggestive of left ventricular hypertrophy lvh, pathological q waves and poor r wave progression, with some abnormalities affecting the t wave and st segment. Types of cardiomyopathy dilated cardiomyopathy dilated cardiomyopathy is the most common type of the disease. Dilated cardiomyopathy brazil pdf ppt case reports. This book is intended as an ecg curriculum that emphasizes practice. Fragmented qrs complex dilated cardiomyopathy ventricular. This book is distributed under the terms of the creative commons. Goldbergers triad in dilated cardiomyopathycan it predict. Dilated cardiomyopathy dcm litfl ecg library diagnosis. First, read the introductory chapters that explain ecg findings and provide.
Changes in left ventricular synchrony and systolic function in dilated. Reprints and eprints sponsored supplements branded books journals career network. Diagnosis and assessment of dilated cardiomyopathy. Echo assessment of cardiomyopathy pdf slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Determining the etiology of dilated cardiomyopathy is a key element in the management and prognosis of a patient with heart failure hf. Symptoms include dyspnea, fatigue, and peripheral edema. Dilated cardiomyopathy is the most common form of nonischemic cardiomyopathy.
Left bundle branch block lbbb statpearls ncbi bookshelf. The fourstep algorithm for dilated cardiomyopathy included a paced ventricular rhythm or pr. Dilated cardiomyopathy dcm usually presents with electrocardiographic ecg signs of left ventric ular lv hypertrophy similar to those seen in hyper tensive patients. A dilated cardiomyopathy b hypertrophic cardiomyopathy c restrictive cardiomyopathy d myocardial infarction e right sided hf questions about dcm 3 a 55 yo african american male presents to your clinic with the following physical exam. Symptoms vary from none to feeling tired, leg swelling, and shortness of breath.
Cardiomyopathies are diseases of the myocardium associated with cardiac dysfunction, often resulting in the clinical syndrome of heart failure. In patients with recentonset hf and concomitant arrhythmias, a. Interventricular conduction delays occur due to cardiac dilatation. The diagnosis and evaluation of dilated cardiomyopathy alan g. If you break down the word cardiomyopathy you can remember that its a disease of the heart muscle because cardio stands for heart, myo muscle, and pathy disease. Diagnosis and evaluation of dilated cardiomyopathy. Five table 2 exclusion criteria prior to making a diagnosis of idiopathic dilated cardiomyopathy note, these criteria can be simply and practically excluded in the living dog. This gives the heart a more rounded rather than the normal cone shape.