Dilated Cardiomyopathy in Emergency Medicine Follow-up

  • Author: Uche A Blackstock, MD; Chief Editor: David FM Brown, MD   more...
 
Updated: Sep 30, 2008
 

Further Inpatient Care

  • The goals of inpatient care are to optimize the balance between intravascular volume and cardiac output and to minimize symptomatology. Determine and reverse specific cause of cardiomyopathy, if possible.
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Further Outpatient Care

  • Patients with dilated cardiomyopathy should be monitored regularly by their primary care provider or a cardiologist.
  • Monitor electrolyte levels.
  • Adjust therapy to minimize symptoms.
  • Refer patients with NYHA functional class III-IV dilated cardiomyopathy to a cardiothoracic surgeon for possible surgical intervention (eg, partial left ventriculectomy, heart transplant).
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Inpatient & Outpatient Medications

  • ACE inhibitor
  • Diuretic
  • Digoxin
  • Beta-blocker
  • Aldosterone antagonist
  • Anticoagulant
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Deterrence/Prevention

  • Many exacerbations can be avoided with a low-sodium diet and medication compliance.
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Complications

  • Heart failure
  • Volume overload
  • Pulmonary edema
  • Hypoxia
  • Cardiogenic shock
  • Death
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Prognosis

  • The Framingham heart study found that approximately 50% of patients diagnosed with CHF died within 5 years.[2]
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Patient Education

  • Dietary counseling on a low-sodium diet is a mainstay in the outpatient management of these patients.
  • For excellent patient education resources, visit eMedicine's Heart Center. Also, see eMedicine's patient education article Congestive Heart Failure.
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Contributor Information and Disclosures
Author

Uche A Blackstock, MD  Staff Physician, Department of Emergency Medicine, Kings County Hospital Center, State University of New York Downstate

Disclosure: Nothing to disclose.

Coauthor(s)

Richard H Sinert, DO  Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

David FM Brown, MD  Associate Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital

David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

A Antoine Kazzi, MD  Chair and Medical Director, Department of Emergency Medicine, American University of Beirut, Lebanon

A Antoine Kazzi, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

David FM Brown, MD  Associate Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital

David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References

  1. Heart Disease and Stroke Facts. Dallas: American Heart Association; 2006.

  2. McKee PA, Castelli WP, McNamara PM, Kannel WB. The natural history of congestive heart failure: the Framingham study. N Engl J Med. Dec 23 1971;285(26):1441-6. [Medline].

  3. La Vecchia L, Mezzena G, Zanolla L, Paccanaro M, Varotto L, Bonanno C, et al. Cardiac troponin I as diagnostic and prognostic marker in severe heart failure. J Heart Lung Transplant. Jul 2000;19(7):644-52. [Medline].

  4. Peacock WF, Emerman CE, Doleh M, Civic K, Butt S. Retrospective review: the incidence of non-ST segment elevation MI in emergency department patients presenting with decompensated heart failure. Congest Heart Fail. Nov-Dec 2003;9(6):303-8. [Medline].

  5. [Best Evidence] Wang CS, FitzGerald JM, Schulzer M, Mak E, Ayas NT. Does this dyspneic patient in the emergency department have congestive heart failure?. JAMA. Oct 19 2005;294(15):1944-56. [Medline].

  6. Baker DW, Wright RF. Management of heart failure. IV. Anticoagulation for patients with heart failure due to left ventricular systolic dysfunction. JAMA. Nov 23-30 1994;272(20):1614-8. [Medline].

  7. Mason JW, O'Connell JB, Herskowitz A, Rose NR, McManus BM, Billingham ME. A clinical trial of immunosuppressive therapy for myocarditis. The Myocarditis Treatment Trial Investigators. N Engl J Med. Aug 3 1995;333(5):269-75. [Medline].

  8. Swedburg K, CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). The CONSENSUS Trial Study Group. N Engl J Med. Jun 4 1987;316(23):1429-35. [Medline].

  9. The SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med. Aug 1 1991;325(5):293-302. [Medline].

  10. Jaeschke R, Oxman AD, Guyatt GH. To what extent do congestive heart failure patients in sinus rhythm benefit from digoxin therapy? A systematic overview and meta-analysis. Am J Med. Mar 1990;88(3):279-86. [Medline].

  11. Rich MW, McSherry F, Williford WO, Yusuf S, Digitalis Investigation Group. Effect of age on mortality, hospitalizations and response to digoxin in patients with heart failure: the DIG study. J Am Coll Cardiol. Sep 2001;38(3):806-13. [Medline].

  12. Waagstein F, Bristow MR, Swedberg K, Camerini F, Fowler MB, Silver MA, et al. Beneficial effects of metoprolol in idiopathic dilated cardiomyopathy. Metoprolol in Dilated Cardiomyopathy (MDC) Trial Study Group. Lancet. Dec 11 1993;342(8885):1441-6. [Medline].

  13. Packer M, Bristow MR, Cohn JN, Colucci WS, Fowler MB, Gilbert EM. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. U.S. Carvedilol Heart Failure Study Group. N Engl J Med. May 23 1996;334(21):1349-55. [Medline].

  14. MERIT-HF Trial. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet. Jun 12 1999;353(9169):2001-7. [Medline].

  15. Cohn JN, Archibald DG, Ziesche S, Franciosa JA, Harston WE, Tristani FE, et al. Effect of vasodilator therapy on mortality in chronic congestive heart failure. Results of a Veterans Administration Cooperative Study. N Engl J Med. Jun 12 1986;314(24):1547-52. [Medline].

  16. Taylor AL, Ziesche S, Yancy C, Carson P, D'Agostino R Jr, Ferdinand K. Combination of isosorbide dinitrate and hydralazine in blacks with heart failure. N Engl J Med. Nov 11 2004;351(20):2049-57. [Medline].

  17. Pitt B, Zannad F, Remme WJ, Cody R, Castaigne A, Perez A, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med. Sep 2 1999;341(10):709-17. [Medline].

  18. Abelmann WH. Classification and natural history of primary myocardial disease. Prog Cardiovasc Dis. Sep-Oct 1984;27(2):73-94. [Medline].

  19. Agostini D, Belin A, Amar MH, Darlas Y, Hamon M, Grollier G, et al. Improvement of cardiac neuronal function after carvedilol treatment in dilated cardiomyopathy: a 123I-MIBG scintigraphic study. J Nucl Med. May 2000;41(5):845-51. [Medline].

  20. Allen LA, O'Connor CM. Management of acute decompensated heart failure. CMAJ. Mar 13 2007;176(6):797-805. [Medline].

  21. Alonso-Martinez JL, Llorente-Diez B, Echegaray-Agara M, Olaz-Preciado F, Urbieta-Echezarreta M, Gonzalez-Arencibia C, et al. C-reactive protein as a predictor of improvement and readmission in heart failure. Eur J Heart Fail. Jun 2002;4(3):331-6. [Medline].

  22. American Heart Association. Heart disease and stroke statistics - 2004 update. Dallas, TX: American Heart Association; 2003.

  23. Arbustini E, Morbini P, Pilotto A, Gavazzi A, Tavazzi L. Genetics of idiopathic dilated cardiomyopathy. Herz. May 2000;25(3):156-60. [Medline].

  24. Azevedo VM, Albanesi Filho FM, Santos MA, Castier MB, Tura BR. How can the echocardiogram be useful for predicting death in children with idiopathic dilated cardiomyopathy?. Arq Bras Cardiol. Jun 2004;82(6):505-14. [Medline].

  25. Berger R, Huelsman M, Strecker K, Bojic A, Moser P, Stanek B, et al. B-type natriuretic peptide predicts sudden death in patients with chronic heart failure. Circulation. May 21 2002;105(20):2392-7. [Medline].

  26. Binanay C, Califf RM, Hasselblad V, O'Connor CM, Shah MR, Sopko G, et al. Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial. JAMA. Oct 5 2005;294(13):1625-33. [Medline].

  27. Bristow MR, Gilbert EM, Abraham WT, Adams KF, Fowler MB, Hershberger RE, et al. Carvedilol produces dose-related improvements in left ventricular function and survival in subjects with chronic heart failure. MOCHA Investigators. Circulation. Dec 1 1996;94(11):2807-16. [Medline].

  28. Chizzola PR, Freitas HF, Caldas MA, da Costa JM, Meneghetti C, Marinho NV, et al. Effects of carvedilol in heart failure due to dilated cardiomyopathy. Results of a double-blind randomized placebo-controlled study (CARIBE study). Arq Bras Cardiol. Mar 2000;74(3):233-42. [Medline].

  29. Chung P, Hermann L. Acute decompensated heart failure: formulating an evidence-based approach to diagnosis and treatment (part I). Mt Sinai J Med. Mar 2006;73(2):506-15. [Medline].

  30. Cohen N, Muntoni F. Multiple pathogenetic mechanisms in X linked dilated cardiomyopathy. Heart. Aug 2004;90(8):835-41. [Medline].

  31. Cohn JN, Johnson G, Ziesche S, Cobb F, Francis G, Tristani F, et al. A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure. N Engl J Med. Aug 1 1991;325(5):303-10. [Medline].

  32. Cotter G, Metzkor E, Kaluski E, Faigenberg Z, Miller R, Simovitz A, et al. Randomised trial of high-dose isosorbide dinitrate plus low-dose furosemide versus high-dose furosemide plus low-dose isosorbide dinitrate in severe pulmonary oedema. Lancet. Feb 7 1998;351(9100):389-93. [Medline].

  33. Cuffe MS, Califf RM, Adams KF Jr, Benza R, Bourge R, Colucci WS, et al. Short-term intravenous milrinone for acute exacerbation of chronic heart failure: a randomized controlled trial. JAMA. Mar 27 2002;287(12):1541-7. [Medline].

  34. Di Lenarda A, Sabbadini G, Salvatore L, Sinagra G, Mestroni L, Pinamonti B, et al. Long-term effects of carvedilol in idiopathic dilated cardiomyopathy with persistent left ventricular dysfunction despite chronic metoprolol. The Heart-Muscle Disease Study Group. J Am Coll Cardiol. Jun 1999;33(7):1926-34. [Medline].

  35. Eichhorn EJ. Medical therapy of chronic heart failure. Role of ACE inhibitors and beta-blockers. Cardiol Clin. Nov 1998;16(4):711-25, ix. [Medline].

  36. Eichhorn EJ. The paradox of beta-adrenergic blockade for the management of congestive heart failure. Am J Med. May 1992;92(5):527-38. [Medline].

  37. Etoch SW, Koenig SC, Laureano MA, Cerrito P, Gray LA, Dowling RD. Results after partial left ventriculectomy versus heart transplantation for idiopathic cardiomyopathy. J Thorac Cardiovasc Surg. May 1999;117(5):952-9. [Medline].

  38. [Guideline] Fatkin D. Guidelines for the diagnosis and management of familial dilated cardiomyopathy. Heart Lung Circ. Feb 2007;16(1):19-21. [Medline].

  39. Fedak PW, Smookler DS, Kassiri Z, Ohno N, Leco KJ, Verma S, et al. TIMP-3 deficiency leads to dilated cardiomyopathy. Circulation. Oct 19 2004;110(16):2401-9. [Medline].

  40. Felker GM, Hu W, Hare JM, Hruban RH, Baughman KL, Kasper EK. The spectrum of dilated cardiomyopathy. The Johns Hopkins experience with 1,278 patients. Medicine (Baltimore). Jul 1999;78(4):270-83. [Medline].

  41. Gilbert EM, Abraham WT, Olsen S, Hattler B, White M, Mealy P, et al. Comparative hemodynamic, left ventricular functional, and antiadrenergic effects of chronic treatment with metoprolol versus carvedilol in the failing heart. Circulation. Dec 1 1996;94(11):2817-25. [Medline].

  42. Harrison A, Morrison LK, Krishnaswamy P, Kazanegra R, Clopton P, Dao Q, et al. B-type natriuretic peptide predicts future cardiac events in patients presenting to the emergency department with dyspnea. Ann Emerg Med. Feb 2002;39(2):131-8. [Medline].

  43. [Guideline] Heart Failure Society of America. Executive summary: HFSA 2006 Comprehensive Heart Failure Practice Guideline. J Card Fail. Feb 2006;12(1):10-38. [Medline].

  44. Hermida-Prieto M, Monserrat L, Castro-Beiras A, Laredo R, Soler R, Peteiro J, et al. Familial dilated cardiomyopathy and isolated left ventricular noncompaction associated with lamin A/C gene mutations. Am J Cardiol. Jul 1 2004;94(1):50-4. [Medline].

  45. Hjalmarson A, Kneider M, Waagstein F. The role of beta-blockers in left ventricular dysfunction and heart failure. Drugs. Oct 1997;54(4):501-10. [Medline].

  46. Lotze U, Egerer R, Tresselt C, Glück B, Dannberg G, Stelzner A, et al. Frequent detection of parvovirus B19 genome in the myocardium of adult patients with idiopathic dilated cardiomyopathy. Med Microbiol Immunol. May 2004;193(2-3):75-82. [Medline].

  47. Läer S, Mir TS, Behn F, Eiselt M, Scholz H, Venzke A, et al. Carvedilol therapy in pediatric patients with congestive heart failure: a study investigating clinical and pharmacokinetic parameters. Am Heart J. May 2002;143(5):916-22. [Medline].

  48. Marius-Nunez AL, Heaney L, Fernandez RN, Clark WA, Ranganini A, Silber E, et al. Intermittent inotropic therapy in an outpatient setting: a cost-effective therapeutic modality in patients with refractory heart failure. Am Heart J. Oct 1996;132(4):805-8. [Medline].

  49. Maron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, Arnett D, et al. Contemporary definitions and the classification of the cardiomyopathies. Circulation. 2006;113:1807-16. [Medline].

  50. McMahon CJ, Nagueh SF, Eapen RS, Dreyer WJ, Finkelshtyn I, Cao X, et al. Echocardiographic predictors of adverse clinical events in children with dilated cardiomyopathy: a prospective clinical study. Heart. Aug 2004;90(8):908-15. [Medline].

  51. Medical letter on drugs and therapeutics. Drugs for chronic heart failure. Med Lett Drugs Ther. Oct 11 1996;38(985):92-4. [Medline].

  52. Mestroni L, Rocco C, Vatta M, Miocic S, Giacca M. Advances in molecular genetics of dilated cardiomyopathy. The Heart Muscle Disease Study Group. Cardiol Clin. Nov 1998;16(4):611-21, vii. [Medline].

  53. Metra M, Giubbini R, Nodari S, Boldi E, Modena MG, Dei Cas L. Differential effects of beta-blockers in patients with heart failure: A prospective, randomized, double-blind comparison of the long-term effects of metoprolol versus carvedilol. Circulation. Aug 1 2000;102(5):546-51. [Medline].

  54. Mobini R, Maschke H, Waagstein F. New insights into the pathogenesis of dilated cardiomyopathy: possible underlying autoimmune mechanisms and therapy. Autoimmun Rev. Jun 2004;3(4):277-84. [Medline].

  55. National Center for Health Statistics. National hospital discharge survey 2001. Available at http://www.cdc.gov/nchs/data/hdasd/sr13_156t11.pdf.

  56. Packer M, Colucci WS, Sackner-Bernstein JD, Liang CS, Goldscher DA, Freeman I, et al. Double-blind, placebo-controlled study of the effects of carvedilol in patients with moderate to severe heart failure. The PRECISE Trial. Prospective Randomized Evaluation of Carvedilol on Symptoms and Exercise. Circulation. Dec 1 1996;94(11):2793-9. [Medline].

  57. Pfeffer MA, Braunwald E, Moye LA, Basta L, Brown EJ Jr, Cuddy TE, et al. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE Investigators. N Engl J Med. Sep 3 1992;327(10):669-77. [Medline].

  58. Pitt B, Segal R, Martinez FA, Meurers G, Cowley AJ, Thomas I. Randomised trial of losartan versus captopril in patients over 65 with heart failure (Evaluation of Losartan in the Elderly Study, ELITE). Lancet. Mar 15 1997;349(9054):747-52. [Medline].

  59. Publication Committee for the VMAC Investigators. Intravenous nesiritide vs nitroglycerin for treatment of decompensated congestive heart failure: a randomized controlled trial. JAMA. Mar 27 2002;287(12):1531-40. [Medline].

  60. Publication Committee for the VMAC Investigators (Vasodilatation in the Management of Acute CHF). Intravenous nesiritide versus nitroglycerin for treatment of decompensated congestive heart failure: a randomized controlled trial. JAMA. 2002;287:1531-40. [Medline].

  61. Ramires FJ, Mansur A, Coelho O, Maranhao M, Gruppi CJ, Mady C, et al. Effect of spironolactone on ventricular arrhythmias in congestive heart failure secondary to idiopathic dilated or to ischemic cardiomyopathy. Am J Cardiol. May 15 2000;85(10):1207-11. [Medline].

  62. Richardson P, McKenna W, Bristow M, Maisch B, Mautner B, O'Connell J, et al. Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of cardiomyopathies. Circulation. Mar 1 1996;93(5):841-2. [Medline].

  63. Ripa S, Ripa R, Giustiniani S. Are failured cardiomyopathies a zinc-deficit related disease? A study on Zn and Cu in patients with chronic failured dilated and hypertrophic cardiomyopathies. Minerva Med. Nov-Dec 1998;89(11-12):397-403. [Medline].

  64. Riza Erbay A, Turhan H, Aksoy Y, Senen K, Yetkin E. Activation of coagulation system in dilated cardiomyopathy: comparison of patients with and without left ventricular thrombus. Coron Artery Dis. Aug 2004;15(5):265-8. [Medline].

  65. Rusconi P, Gomez-Marin O, Rossique-Gonzalez M, Redha E, Marin JR, Lon-Young M, et al. Carvedilol in children with cardiomyopathy: 3-year experience at a single institution. J Heart Lung Transplant. Jul 2004;23(7):832-8. [Medline].

  66. Shannon JJ. Medical therapy for congestive heart failure: 1994 update. Resid Staff Physician. 1994;13-20.

  67. Silver MA, Horton DP, Ghali JK, Elkayam U. Effect of nesiritide versus dobutamine on short-term outcomes in the treatment of patients with acutely decompensated heart failure. J Am Coll Cardiol. Mar 6 2002;39(5):798-803. [Medline].

  68. Silver MA, Maisel A, Yancy CW, McCullough PA, Burnett JC Jr, Francis GS, et al. BNP Consensus Panel 2004: A clinical approach for the diagnostic, prognostic, screening, treatment monitoring, and therapeutic roles of natriuretic peptides in cardiovascular diseases. Congest Heart Fail. Sep-Oct 2004;10(5 Suppl 3):1-30. [Medline].

  69. Suma H, Isomura T, Horii T, Sato T, Kikuchi N, Hosokawa G. Isolated effect of partial left ventriculectomy for dilated cardiomyopathy: a case report. J Cardiol. May 1999;33(5):273-7. [Medline].

  70. The Captopril-Digoxin Multicenter Research Group. Comparative effects of therapy with captopril and digoxin in patients with mild to moderate heart failure. JAMA. Jan 22-29 1988;259(4):539-44. [Medline].

  71. The SOLVD Investigators. Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. N Engl J Med. Sep 3 1992;327(10):685-91. [Medline].

  72. Tintinalli JE. Emergency Medicine. In: A Comprehensive Study Guide. 4th ed. McGraw-Hill Co: 1996:354-367.

  73. Towbin JA, Bowles NE. Genetic abnormalities responsible for dilated cardiomyopathy. Curr Cardiol Rep. Sep 2000;2(5):475-80. [Medline].

 
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