eMedicine Specialties > Emergency Medicine > Cardiovascular

Cardiomyopathy, Dilated

Author: Uche A Blackstock, MD, Staff Physician, Department of Emergency Medicine, Kings County Hospital Center, State University of New York Downstate
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
Contributor Information and Disclosures

Updated: Sep 30, 2008

Introduction

Background

Cardiomyopathies are an important and heterogeneous group of diseases. The concept of heart muscle disease has a notable and evolving history. In the mid 1850s, chronic myocarditis was the only recognized cause of heart muscle disease. In 1900, the designation of primary myocardial disease was introduced, and it was not until 1957 that the term "cardiomyopathy" was used for the first time. Over the subsequent years, a number of definitions for cardiomyopathies have been advanced in concert with an increasing understanding of these diseases.

Cardiomyopathies have traditionally been divided into 3 types (ie, dilated, hypertrophic, restrictive); however, the classification of cardiomyopathies continues to evolve based on the rapid evolution of molecular genetics as well as the introduction of recently described diseases. For the purposes of this article, dilated cardiomyopathy refers to the subset of cardiomyopathies characterized by dilation and contractile dysfunction of the left and right ventricles that is not due to hypertension or ischemic heart disease. 

Pathophysiology

A diverse range of conditions that promote cardiomyocyte injury or loss may cause dilated cardiomyopathy. Dilated cardiomyopathy is characterized by ventricular chamber enlargement and systolic dysfunction with normal left ventricle (LV) wall thickness. Ventricular enlargement and dysfunction generally leads to progressive heart failure with further decline in LV contractile function. Sequelae include ventricular and supraventricular arrhythmias, conduction system abnormalities, thromboembolism, and sudden or heart failure–related death.

Compensatory mechanisms associated with low cardiac output induce reflex upregulation of sympathetic tone and the renin-angiotensin axis, causing increased release of vasopressin, aldosterone, and atrial natriuretic peptide. Stimulation of these hormonal tracts results in volume expansion, which induces vasoconstriction. Vasoconstriction increases afterload that, in turn, decreases stroke volume. As cardiac output depends on stroke volume and heart rate, vasoconstriction ultimately can contribute to decreased cardiac output. Treatment of dilated cardiomyopathy is directed at interrupting this negative cycle.

Frequency

United States

Dilated cardiomyopathy is a common and largely irreversible form of heart muscle disease with an estimated prevalence of 1:2500. It is the third most common cause of heart failure and the most frequent cause of heart transplantation.

In total, an estimated 5 million Americans experience heart failure (including those with left ventricular failure), with more than 500,000 new cases diagnosed annually.

Mortality/Morbidity

From 1993-2003 deaths from heart failure increased by 20.5%. The 2003 death rate was 19.7 per 100,000 overall.1 Demographic distribution of the death rate was as follows:

  • White males - 20.5 per 100,000
  • White females - 18.4 per 100,000
  • Black males - 23.4 per 100,000
  • Black females - 20.4 per 100,000
The 60-day mortality rate following hospital admission due to an exacerbation of congestive heart failure (CHF) is 8-20% depending on the population studied.

The Framingham study2 Long-term survival was found to be inversely proportional to the severity of disease on initial diagnosis.

Hyponatremia at the time of presentation was found to be a marker of increased stimulation of the renin-angiotensin axis and of worsening of the disease course and prognosis.

Age

Dilated cardiomyopathy may manifest clinically at a wide range of ages (most commonly in the third or fourth decade but also in young children).

Clinical

History

  • Determine the severity of disease, possible causes, and symptomatology when taking the history of a patient with suspected cardiomyopathy. Symptoms are a good indicator of the severity of the disease and may include the following:
    • Fatigue
    • Dyspnea on exertion, shortness of breath
    • Orthopnea, paroxysmal nocturnal dyspnea
    • Increasing edema, weight, or abdominal girth 
  • Note other important patient information, including the following:
    • Age
    • Sex
    • Race
    • Medical history, especially the following:
      • Hypertension
      • Angina
      • Coronary artery disease
      • Anemia
      • Thyroid dysfunction
      • Breast cancer
      • Prior history of heart failure or myocardial injury
    • Medications (especially new medications or lack of compliance with current medications)
    • Social history (eg, tobacco, alcohol, illicit drug use)
    • Family history of cardiomyopathy or sudden cardiac death

Physical

  • On physical examination, look for signs of heart failure and volume overload. Assess vital signs with specific attention to the following:
    • Tachypnea
    • Tachycardia
    • Hypertension
  • Other pertinent findings include the following:
    • Signs of hypoxia
    • Jugular venous distension (JVD)
    • Pulmonary edema (crackles and/or wheezes)
    • S3 gallop
    • Enlarged liver or presence of hepatojugular reflex
    • Peripheral edema

Causes

About 20-30% of dilated cardiomyopathy cases have been reported as familial, although with incomplete and age-dependent penetrance, and linked to a diverse group of more than 20 loci and genes. Although genetically heterogeneous, the predominant mode of inheritance for dilated cardiomyopathy is autosomal dominant, with X-linked, autosomal recessive, and mitochondrial inheritance less frequent. Several of the mutant genes linked to autosomal dominant dilated cardiomyopathy encode the same contractile sarcomeric proteins that are responsible for hypertrophic cardiomyopathy, including α-cardiac actin; α-tropomyosin; cardiac troponin T, I, and C; and β- and α-myosin heavy chain. Research to determine further disease loci is ongoing.

The dilated cardiomyopathy phenotype with sporadic occurrence may derive from a particularly broad range of primary (and secondary) causes, including the following:

  • Chronic excessive alcohol consumption
  • Other drugs
    • Heavy metals
    • Emetine
    • Anthracyclines (daunorubicin and doxorubicin)
    • Cocaine
    • Methamphetamine
    • Cobalt
  • Infections
    • Viral endocarditis/myocarditis (coxsackievirus, adenovirus, parvovirus, human immunodeficiency virus [HIV])
    • Parasites
    • Protozoa
    • Chagas disease (most common cause in parts of South America)
  • High-output states
    • Anemia
    • Thyrotoxicosis
    • Pregnancy
  • Collagen vascular disease
  • Glycogen storage disease, type IV also known as Andersen disease is associated with DCM. 
  • Thiamine deficiency and zinc deficiency
  • Hypophosphatemia
  • Amyloidosis
  • Neuromuscular disorders (Duchenne/Becker and Emery-Dreifuss muscular dystrophies)
  • Pheochromocytoma

More on Cardiomyopathy, Dilated

Overview: Cardiomyopathy, Dilated
Differential Diagnoses & Workup: Cardiomyopathy, Dilated
Treatment & Medication: Cardiomyopathy, Dilated
Follow-up: Cardiomyopathy, Dilated
References
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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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Further Reading

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Keywords

dilated cardiomyopathy, cardiomyopathy, disease of the myocardium, heart disease, low cardiac output, cardiac failure, heart failure, congestive heart disease, CHD, congestive heart failure, CHF, contractile dysfunction, ventricular chamber enlargement, systolic dysfunction, ventricular arrhythmias, supraventricular arrhythmias, conduction system abnormalities, thromboembolism, sudden death

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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.

Medical Editor

David FM Brown, MD, Assistant Professor, Department of Medicine, Division of Emergency Medicine, Harvard Medical School; Associate-Chief, Attending Physician, 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: Schering  Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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.

CME Editor

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

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: eMedicine.com, Inc. Consulting fee Consulting

 
 
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