eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Cardiology

Cardiomyopathy, Dilated: Follow-up

Author: Poothirikovil Venugopalan, MBBS, MD, FRCP (Glasg), FRCPCH, Consulting Staff, Department of Child Health, University Hospital of Hartlepool, UK
Contributor Information and Disclosures

Updated: Nov 12, 2008

Follow-up

Further Inpatient Care

  • Admission is necessitated for patients with dilated cardiomyopathy (DCM) who have exacerbations of heart failure often precipitated by chest infection. Admission may also be necessary for reevaluation if first-line medications fail to provide significant relief of symptoms (resistant heart failure). During terminal illness, patients and parents might opt to stay in the hospital.
  • In addition to taking aggressive steps to treat the precipitating factor (infection, anemia), compliance to therapy has to be evaluated when symptoms persist.
  • Diminished absorption and waning action of diuretics can be partially overcome by parenteral administration of furosemide or by sequential segmental nephron blockade achieved by combining metolazone, a thiazide diuretic, with furosemide.
  • Intravenous infusions of beta agonists, such as dopamine and dobutamine, temporarily improve myocardial function and partly reverse the abnormal neuro-endocrine profile of chronic congestive heart failure. However, in the long-term, they increase myocardial irritability, leading to arrhythmia.
  • Intra-aortic balloon pump support may be successfully and safely used in patients with acute decompensated DCM as an urgent measure of cardiac support to stabilize the patient and maintain organ perfusion until transplantation is possible, until a ventricular assist device is placed, or until the patient is weaned from intra-aortic balloon pump.23
  • Recently, use of beta-blocker therapy in children with chronic congestive heart failure due to DCM was shown to improve symptoms and left ventricular ejection fraction. Carvedilol is a beta-adrenergic blocker with additional vasodilating action. Carvedilol, in addition to standard therapy for dilated cardiomyopathy in children, improves cardiac function and symptoms; it is well tolerated, with minimal adverse effects, but close monitoring is necessary because it might worsen congestive heart failure and precipitate asthma.
  • Anticoagulants and antiarrhythmic agents, particularly amiodarone, are often used in patients with low myocardial contractility and symptomatic arrhythmias, respectively. Results are encouraging. Presence of intracardiac thrombi, symptomatic or not, is another indication for anticoagulant therapy.24
  • Cardiac resynchronization therapy with AV synchronous biventricular pacing has been successful in some children with DCM and left bundle branch block (LBBB). Optimization of resynchronization for children with DCM is still in the early stages.
  • Automatic implantable cardioverter-defibrillators (ICDs) reduce sudden death, and their efficacy has been clearly demonstrated in adults with chronic congestive heart failure. However, their use in children has been limited. Recent studies have reported on the efficacy of ICDs in children with DCM and other cardiomyopathies.25
  • Studies in adults who died from heart failure report significant fatigue, dyspnea, and pain in the days before death. Concluding that similar problems in children is logical.

Further Outpatient Care

Inpatient & Outpatient Medications

Transfer

  • Transfer may be required for further diagnostic evaluation and surgical intervention (cardiac transplantation).

Complications

  • Congestive heart failure
  • Pneumonia
  • Cardiac arrhythmias (supraventricular and ventricular)
  • Infective endocarditis
  • Thromboembolism
  • Venous thrombosis
  • Cardiac cirrhosis
  • Post-transplant complications
  • Sudden, unexplained death

Prognosis

  • If a treatable cause is discovered, prognosis is better.
  • Prognosis is worst for cardiomyopathy secondary to storage diseases that do not have effective therapy.
  • History of viral illness in the 3 months before onset may suggest a better prognosis.
  • In DCM with no obvious detectable etiology, outcome depends on severity of myocardial dysfunction, improvement during the first year after onset, compliance to therapy, and availability of timely transplant.
  • Degree of depression of fractional shortening or ejection fraction at time of initial echocardiography, elevation of left ventricular end diastolic pressure, and cardiothoracic ratio have all been applied as predictors of outcome, although they are not often predictive. Other possible prognostic factors include age at onset (better for infants), presence of symptomatic arrhythmias, and thromboembolic episodes.
  • Arrhythmic death can occur even after the left ventricular ejection fraction has returned to normal.
  • Following cardiac transplant, survival rates of as much as 77% at 1 year and as much as 65% at 5 years have been reported in children.

Patient Education

  • Education is a continuous process from the time of diagnosis. Explain the disease process, management, and prognosis to parents and older patients.
  • Compliance to medication is an important factor in the success of therapy. Compliance is affected by complexity of the dosing regime, perceptions of illness, benefits of treatment, and family dynamics.
    • Increased dosage frequency, timing of drug administration during school hours, and unpalatability increase noncompliance. Young children may not understand the benefits of treatment, whereas adolescents may exhibit independence or denial.
    • Family dynamics can include parental anxiety, parental preoccupation, and unstable marital relationships.
    • Effective communication is a confounding problem when a family member who is not the primary care provider accompanies the child to the hospital.
    • Educating and counseling parents and caretakers, with the help of models, diagrams, and written instructions, lessen the problem.
    • Concordance, in which the pediatrician forms a therapeutic alliance with the caretaker and the child, and negotiation with the family to choose the best-fit regime have been found to improve compliance.
  • Patients should avoid competitive sports.
  • Patients should avoid activity beyond tolerance.
  • In patients with chronic illness, regular graded exercise has been shown to improve effort tolerance and quality of life.
  • For excellent patient education resources, visit eMedicine's Heart Center. Also, see eMedicine's patient education article Heart and Lung Transplant.

Miscellaneous

Medicolegal Pitfalls

  • Failure to identify a treatable cause (including congenital aortic stenosis, coarctation of aorta, ALCAPA, and congenital mitral regurgitation) of dilated cardiomyopathy (DCM)
  • Failure to diagnose the disease in infants who present with predominantly respiratory symptoms
  • Failure to inform patients and parents of the diagnosis, prognosis, and treatment options
  • Failure to inform patients of the complications of cardiac transplantation
  • Failure to discuss potential interventional treatment options such as cardiac resynchronization therapy, implantable defibrillators, or ventricular assist devices

Special Concerns

  • Schoolteachers should be informed of the child's condition. Teachers and other caregivers should be adequately trained for first aid and cardiopulmonary resuscitation (CPR).
  • Family members should be screened with ECG and echocardiography to detect asymptomatic cases.
  • Pregnancy imposes special demands on the cardiac reserve, and the decision to have children has to be individualized, depending mainly on the degree of exercise tolerance and the severity of ventricular dysfunction and cardiomyopathy.
 


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References
[ CLOSE WINDOW ]

References

  1. McMahon CJ, Pignatelli RH, Nagueh SF, et al. Left ventricular non-compaction cardiomyopathy in children: characterisation of clinical status using tissue Doppler-derived indices of left ventricular diastolic relaxation. Heart. Jun 2007;93(6):676-81. [Medline].

  2. Towbin JA, Lowe AM, Colan SD, et al. Incidence, causes, and outcomes of dilated cardiomyopathy in children. JAMA. Oct 18 2006;296(15):1867-76. [Medline].

  3. Arola A, Tuominen J, Ruuskanen O, Jokinen E. Idiopathic dilated cardiomyopathy in children: prognostic indicators and outcome. Pediatrics. Mar 1998;101(3 Pt 1):369-76. [Medline].

  4. [Best Evidence] Andrews RE, Fenton MJ, Ridout DA, Burch M. New-onset heart failure due to heart muscle disease in childhood: a prospective study in the United kingdom and Ireland. Circulation. Jan 1 2008;117(1):79-84. [Medline].

  5. Griffin ML, Hernandez A, Martin TC, et al. Dilated cardiomyopathy in infants and children. J Am Coll Cardiol. Jan 1988;11(1):139-44. [Medline].

  6. Akagi T, Benson LN, Lightfoot NE, et al. Natural history of dilated cardiomyopathy in children. Am Heart J. May 1991;121(5):1502-6. [Medline].

  7. Chen SC, Nouri S, Balfour I, Jureidini S, Appleton RS. Clinical profile of congestive cardiomyopathy in children. J Am Coll Cardiol. Jan 1990;15(1):189-93. [Medline].

  8. Venugopalan P, Houston AB, Agarwal AK. The outcome of idiopathic dilated cardiomyopathy and myocarditis in children from the west of Scotland. Int J Cardiol. Apr 2001;78(2):135-41. [Medline].

  9. Venugopalan P, Agarwal AK, Akinbami FO. Improved prognosis of heart failure due to idiopathic dilated cardiomyopathy in children. Int J Cardiol. Jul 1 1998;65(2):125-8. [Medline].

  10. Connuck DM, Sleeper LA, Colan SD, et al. Characteristics and outcomes of cardiomyopathy in children with Duchenne or Becker muscular dystrophy: a comparative study from the Pediatric Cardiomyopathy Registry. Am Heart J. Jun 2008;155(6):998-1005. [Medline].

  11. Bowles NE, Ni J, Kearney DL, et al. Detection of viruses in myocardial tissues by polymerase chain reaction. evidence of adenovirus as a common cause of myocarditis in children and adults. J Am Coll Cardiol. Aug 6 2003;42(3):466-72. [Medline].

  12. Fujioka S, Kitaura Y, Ukimura A, et al. Evaluation of viral infection in the myocardium of patients with idiopathic dilated cardiomyopathy. J Am Coll Cardiol. Nov 15 2000;36(6):1920-6. [Medline].

  13. Michels VV, Driscoll DJ, Miller FA, et al. Progression of familial and non-familial dilated cardiomyopathy: long term follow up. Heart. Jul 2003;89(7):757-61. [Medline].

  14. Michels VV, Olson TM, Miller FA, et al. Frequency of development of idiopathic dilated cardiomyopathy among relatives of patients with idiopathic dilated cardiomyopathy. Am J Cardiol. Jun 1 2003;91(11):1389-92. [Medline].

  15. Liu W, Li WM, Sun NL. Relationship between HLA-DQA1 polymorphism and genetic susceptibility to idiopathic dilated cardiomyopathy. Chin Med J (Engl). Oct 2004;117(10):1449-52. [Medline].

  16. Friedberg MK, Roche SL, Balasingam M, et al. Evaluation of mechanical dyssynchrony in children with idiopathic dilated cardiomyopathy and associated clinical outcomes. Am J Cardiol. Apr 15 2008;101(8):1191-5. [Medline].

  17. Senes M, Erbay AR, Yilmaz FM, et al. Coenzyme Q10 and high-sensitivity C-reactive protein in ischemic and idiopathic dilated cardiomyopathy. Clin Chem Lab Med. 2008;46(3):382-6. [Medline].

  18. Morales DL, Dreyer WJ, Denfield SW, et al. Over two decades of pediatric heart transplantation: how has survival changed?. J Thorac Cardiovasc Surg. Mar 2007;133(3):632-9. [Medline].

  19. Tjang YS, Stenlund H, Tenderich G, et al. Risk factor analysis in pediatric heart transplantation. J Heart Lung Transplant. Apr 2008;27(4):408-15. [Medline].

  20. Breinholt JP, Fraser CD, Dreyer WJ, et al. The efficacy of mitral valve surgery in children with dilated cardiomyopathy and severe mitral regurgitation. Pediatr Cardiol. Jan 2008;29(1):13-8. [Medline].

  21. Malaisrie SC, Pelletier MP, Yun JJ, et al. Pneumatic paracorporeal ventricular assist device in infants and children: initial Stanford experience. J Heart Lung Transplant. Feb 2008;27(2):173-7. [Medline].

  22. Janousek J, Gebauer RA. Cardiac resynchronization therapy in pediatric and congenital heart disease. Pacing Clin Electrophysiol. Feb 2008;31 Suppl 1:S21-3. [Medline].

  23. Norkiene I, Ringaitiene D, Rucinskas K, et al. Intra-aortic balloon counterpulsation in decompensated cardiomyopathy patients: bridge to transplantation or assist device. Interact Cardiovasc Thorac Surg. Feb 2007;6(1):66-70. [Medline].

  24. John JB, Cron SG, Kung GC, Mott AR. Intracardiac thrombi in pediatric patients: presentation profiles and clinical outcomes. Pediatr Cardiol. May-Jun 2007;28(3):213-20. [Medline].

  25. Rhee EK, Canter CE, Basile S, Webber SA, Naftel DC. Sudden death prior to pediatric heart transplantation: would implantable defibrillators improve outcome?. J Heart Lung Transplant. May 2007;26(5):447-52. [Medline].

  26. Agostini D, Belin A, Amar MH, 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].

  27. Al-Kiyumi WA, Venugopalan P. Antiphospholipid syndrome presenting as dilated cardiomyopathy in an 11-year-old boy. Acta Cardiol. Aug 2003;58(4):359-61. [Medline].

  28. Arbustini Eloisa AE, Diegoli M, Pasotti M, et al. Gene symbol: CMD1J. Disease: Dilated cardiomyopathy. Hum Genet. Jul 2005;117(2-3):297. [Medline].

  29. Bhagavan HN, Chopra RK. Potential role of ubiquinone (coenzyme Q10) in pediatric cardiomyopathy. Clin Nutr. Jun 2005;24(3):331-8. [Medline].

  30. Borggrefe M, Block M, Breithardt G. Identification and management of the high risk patient with dilated cardiomyopathy. Br Heart J. Dec 1994;72(6 Suppl):S42-5. [Medline].

  31. Brown CA, O'Connell JB. Implications of the Myocarditis Treatment Trial for clinical practice. Curr Opin Cardiol. May 1996;11(3):332-6. [Medline].

  32. Bruns LA, Chrisant MK, Lamour JM, et al. Carvedilol as therapy in pediatric heart failure: an initial multicenter experience. J Pediatr. Apr 2001;138(4):505-11. [Medline].

  33. Burch M, Siddiqi SA, Celermajer DS, et al. Dilated cardiomyopathy in children: determinants of outcome. Br Heart J. Sep 1994;72(3):246-50. [Medline].

  34. Caforio AL. Role of autoimmunity in dilated cardiomyopathy. Br Heart J. Dec 1994;72(6 Suppl):S30-4. [Medline].

  35. Chantranuwat C, Blakey JD, Kobashigawa JA, et al. Sudden, unexpected death in cardiac transplant recipients: an autopsy study. J Heart Lung Transplant. Jun 2004;23(6):683-9. [Medline].

  36. Chi NH, Huang SC, Yu HY, et al. Application of papillary muscle sling concept in an infant as a biological bridge to transplantation. Ann Thorac Surg. Jan 2005;79(1):337-9. [Medline].

  37. Cnota JF, Samson RA. Left bundle branch block in infants with dilated cardiomyopathy conveys a poor prognosis. Cardiol Young. Jan 1999;9(1):55-7. [Medline].

  38. Diogenes MS, Carvalho AC, Succi RC. Reversible cardiomyopathy subsequent to perinatal infection with the human immunodeficiency virus. Cardiol Young. Aug 2003;13(4):373-6. [Medline].

  39. Dubin AM, Berul CI, Bevilacqua LM, et al. The use of implantable cardioverter-defibrillators in pediatric patients awaiting heart transplantation. J Card Fail. Oct 2003;9(5):375-9. [Medline].

  40. El Belghiti MR, Aniba K, Bouskraoui M, Fadouach S. [Cerebral ischemic stroke revealing dilated idiopathic cardiomyopathy in a 10 month-old infant]. Arch Pediatr. Jul 2005;12(7):1166-7. [Medline].

  41. Elliott P. Cardiomyopathy. Diagnosis and management of dilated cardiomyopathy. Heart. Jul 2000;84(1):106-12. [Medline].

  42. Friedman RA, Moak JP, Garson A Jr. Clinical course of idiopathic dilated cardiomyopathy in children. J Am Coll Cardiol. Jul 1991;18(1):152-6. [Medline].

  43. Gagliardi MG, Bevilacqua M, Bassano C, et al. Long term follow up of children with myocarditis treated by immunosuppression and of children with dilated cardiomyopathy. Heart. Oct 2004;90(10):1167-71. [Medline].

  44. Giardini A, Formigari R, Bronzetti G, et al. Modulation of neurohormonal activity after treatment of children in heart failure with carvedilol. Cardiol Young. Aug 2003;13(4):333-6. [Medline].

  45. Gradinac S, Jovanovic I, Dukic M, et al. Partial left ventriculectomy in a two-year-old girl with dilated cardiomyopathy. J Heart Lung Transplant. Apr 1999;18(4):381-3. [Medline].

  46. Grenier MA, Lipshultz SE. Epidemiology of anthracycline cardiotoxicity in children and adults. Semin Oncol. Aug 1998;25(4 Suppl 10):72-85. [Medline].

  47. Groetzner J, Reichart B, Roemer U, et al. Cardiac transplantation in pediatric patients: fifteen-year experience of a single center. Ann Thorac Surg. Jan 2005;79(1):53-60; discussion 61. [Medline].

  48. Guntheroth WG. Improved outcomes of pediatric dilated cardiomyopathy and heart transplantation. J Am Coll Cardiol. May 17 2005;45(10):1733-4; author reply 1734. [Medline].

  49. Horenstein MS, Ross RD, Singh TP, Epstein ML. Carvedilol reverses elevated pulmonary vascular resistance in a child with dilated cardiomyopathy. Pediatr Cardiol. Jan-Feb 2002;23(1):100-2. [Medline].

  50. Karkkainen S, Helio T, Miettinen R, et al. A novel mutation, Ser143Pro, in the lamin A/C gene is common in finnish patients with familial dilated cardiomyopathy. Eur Heart J. May 2004;25(10):885-93. [Medline].

  51. Karkkainen S, Miettinen R, Tuomainen P, et al. A novel mutation, Arg71Thr, in the delta-sarcoglycan gene is associated with dilated cardiomyopathy. J Mol Med. Dec 2003;81(12):795-800. [Medline].

  52. Kinali M, Olpin SE, Clayton PT, et al. Diagnostic difficulties in a case of primary systemic carnitine deficiency with idiopathic dilated cardiomyopathy. Eur J Paediatr Neurol. 2004;8(4):217-9. [Medline].

  53. Kleinert S, Weintraub RG, Wilkinson JL, Chow CW. Myocarditis in children with dilated cardiomyopathy: incidence and outcome after dual therapy immunosuppression. J Heart Lung Transplant. Dec 1997;16(12):1248-54. [Medline].

  54. Kothari SS, Dhopeshwarkar RA, Saxena A, Juneja R. Dilated cardiomyopathy in Indian children. Indian Heart J. Mar-Apr 2003;55(2):147-51. [Medline].

  55. Krell MJ, Kline EM, Bates ER, et al. Intermittent, ambulatory dobutamine infusions in patients with severe congestive heart failure. Am Heart J. Oct 1986;112(4):787-91. [Medline].

  56. Laer S, Mir TS, Behn F, 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].

  57. Lancet. Carnitine deficiency. Lancet. Mar 17 1990;335(8690):631-3. [Medline].

  58. Leprince P, Bonnet N, Rama A, et al. Bridge to transplantation with the Jarvik-7 (CardioWest) total artificial heart: a single-center 15-year experience. J Heart Lung Transplant. Dec 2003;22(12):1296-303. [Medline].

  59. Lev D, Nissenkorn A, Leshinsky-Silver E, et al. Clinical presentations of mitochondrial cardiomyopathies. Pediatr Cardiol. Sep-Oct 2004;25(5):443-50. [Medline].

  60. Lewis AB. Late recovery of ventricular function in children with idiopathic dilated cardiomyopathy. Am Heart J. Aug 1999;138(2 Pt 1):334-8. [Medline].

  61. Lewis AB, Chabot M. Outcome of infants and children with dilated cardiomyopathy. Am J Cardiol. Aug 1 1991;68(4):365-9. [Medline].

  62. Lipshultz SE, Sleeper LA, Towbin JA, et al. The incidence of pediatric cardiomyopathy in two regions of the United States. N Engl J Med. Apr 24 2003;348(17):1647-55. [Medline].

  63. Liu W, Li WM, Sun NL. HLA-DQA1, -DQB1 polymorphism and genetic susceptibility to idiopathic dilated cardiomyopathy in Hans of northern China. Ann Hum Genet. Jul 2005;69(Pt 4):382-8. [Medline].

  64. Luppi P, Rudert WA, Zanone MM, et al. Idiopathic dilated cardiomyopathy: a superantigen-driven autoimmune disease. Circulation. Aug 25 1998;98(8):777-85. [Medline].

  65. Mason JW, O'Connell JB, Herskowitz A, et al. 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].

  66. Matsumiya G, Monta O, Fukushima N, et al. Who would be a candidate for bridge to recovery during prolonged mechanical left ventricular support in idiopathic dilated cardiomyopathy?. J Thorac Cardiovasc Surg. Sep 2005;130(3):699-704. [Medline].

  67. Maunoury C, Acar P, Sidi D. Use of 123I-MIBG scintigraphy to assess the impact of carvedilol on cardiac adrenergic neuronal function in childhood dilated cardiomyopathy. Eur J Nucl Med Mol Imaging. Dec 2003;30(12):1651-6. [Medline].

  68. McElhinney DB, Colan SD, Moran AM. Recombinant human growth hormone treatment for dilated cardiomyopathy in children. Pediatrics. Oct 2004;114(4):e452-8. [Medline].

  69. McMahon CJ, Nagueh SF, Eapen RS, 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].

  70. McNamara DM, Rosenblum WD, Janosko KM, et al. Intravenous immune globulin in the therapy of myocarditis and acute cardiomyopathy. Circulation. Jun 3 1997;95(11):2476-8. [Medline].

  71. Mogensen J, Murphy RT, Shaw T, et al. Severe disease expression of cardiac troponin C and T mutations in patients with idiopathic dilated cardiomyopathy. J Am Coll Cardiol. Nov 16 2004;44(10):2033-40. [Medline].

  72. Narula J, Haider N, Virmani R, et al. Apoptosis in myocytes in end-stage heart failure. N Engl J Med. Oct 17 1996;335(16):1182-9. [Medline].

  73. Nugent AW, Daubeney PE, Chondros P, et al. The epidemiology of childhood cardiomyopathy in Australia. N Engl J Med. Apr 24 2003;348(17):1639-46. [Medline].

  74. Nurnberg JH, Butter C, Abdul-Khaliq H, et al. Successful cardiac resynchronization therapy in a 9-year-old boy with dilated cardiomyopathy. Z Kardiol. Jan 2005;94(1):44-8. [Medline].

  75. O'Connell JB, Moore CK, Waterer HC. Treatment of end stage dilated cardiomyopathy. Br Heart J. Dec 1994;72(6 Suppl):S52-6. [Medline].

  76. Paraskevaidis IA, Adamopoulos S, Tsiapras D, et al. Prognostic usefulness of echocardiographic dobutamine in younger (14 to 25 years) and older (40 to 55 years) patients with idiopathic dilated cardiomyopathy. Am J Cardiol. Jan 15 2004;93(2):251-5. [Medline].

  77. Park OY, Ahn Y, Park WS, et al. Rapid progression from hypertrophic cardiomyopathy to heart failure in a patient with Becker's muscular dystrophy. Eur J Heart Fail. Jun 2005;7(4):684-8. [Medline].

  78. Pittenger B, Gill EA, Holcslaw TL, Bristow MR. Relation of dose of carvedilol to reduction in QT dispersion in patients with mild to moderate heart failure secondary to ischemic or to idiopathic dilated cardiomyopathy. Am J Cardiol. Dec 1 2004;94(11):1459-62. [Medline].

  79. Price JF, Towbin JA, Denfield SW, et al. Arginine vasopressin levels are elevated and correlate with functional status in infants and children with congestive heart failure. Circulation. Jun 1 2004;109(21):2550-3. [Medline].

  80. Quek SC, Hia CP, Yip WC. A surgically correctable cause of dilated cardiomyopathy in infancy. Cardiol Young. Feb 2005;15(1):54-5. [Medline].

  81. Ratnapalan S, Griffiths K, Costei AM, et al. Digoxin-carvedilol interactions in children. J Pediatr. May 2003;142(5):572-4. [Medline].

  82. Rose AG, Park SJ. Pathology in patients with ventricular assist devices: a study of 21 autopsies, 24 ventricular apical core biopsies and 24 explanted hearts. Cardiovasc Pathol. Jan-Feb 2005;14(1):19-23. [Medline].

  83. Rusconi P, Gomez-Marin O, Rossique-Gonzalez 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].

  84. Salzberg S, Lachat M, Zund G, et al. Left ventricular assist device as bridge to heart transplantation--lessons learned with the MicroMed DeBakey axial blood flow pump. Eur J Cardiothorac Surg. Jul 2003;24(1):113-8. [Medline].

  85. Satoh M, Nakamura M, Saitoh H, et al. Tumor necrosis factor-alpha-converting enzyme and tumor necrosis factor- alpha in human dilated cardiomyopathy. Circulation. Jun 29 1999;99(25):3260-5. [Medline].

  86. Sebillon P, Bouchier C, Bidot LD, et al. Expanding the phenotype of LMNA mutations in dilated cardiomyopathy and functional consequences of these mutations. J Med Genet. Aug 2003;40(8):560-7. [Medline].

  87. Shaddy RE, Tani LY, Gidding SS, et al. Beta-blocker treatment of dilated cardiomyopathy with congestive heart failure in children: a multi-institutional experience. J Heart Lung Transplant. Mar 1999;18(3):269-74. [Medline].

  88. Siu BL, Niimura H, Osborne JA, et al. Familial dilated cardiomyopathy locus maps to chromosome 2q31. Circulation. Mar 2 1999;99(8):1022-6. [Medline].

  89. Sliwa K, Norton GR, Kone N, et al. Impact of initiating carvedilol before angiotensin-converting enzyme inhibitor therapy on cardiac function in newly diagnosed heart failure. J Am Coll Cardiol. Nov 2 2004;44(9):1825-30. [Medline].

  90. Soongswang J, Durongpisitkul K, Nana A, et al. Cardiac troponin T: a marker in the diagnosis of acute myocarditis in children. Pediatr Cardiol. Jan-Feb 2005;26(1):45-9. [Medline].

  91. Stefanelli CB, Rosenthal A, Borisov AB, et al. Novel troponin T mutation in familial dilated cardiomyopathy with gender-dependant severity. Mol Genet Metab. Sep-Oct 2004;83(1-2):188-96. [Medline].

  92. Suma H, Isomura T, Horii T, Buckberg G. Role of site selection for left ventriculoplasty to treat idiopathic dilated cardiomyopathy. Heart Fail Rev. Oct 2004;9(4):329-36. [Medline].

  93. Takahashi T, Saegusa S, Sumino H, et al. Adiponectin, T-cadherin and tumour necrosis factor-alpha in damaged cardiomyocytes from autopsy specimens. J Int Med Res. Mar-Apr 2005;33(2):236-44. [Medline].

  94. Tsirka AE, Trinkaus K, Chen SC, et al. Improved outcomes of pediatric dilated cardiomyopathy with utilization of heart transplantation. J Am Coll Cardiol. Jul 21 2004;44(2):391-7. [Medline].

  95. Venugopalan P, Agarwal AK. Plasma catecholamine levels parallel severity of heart failure and have prognostic value in children with dilated cardiomyopathy. Eur J Heart Fail. Oct 2003;5(5):655-8. [Medline].

  96. Venugopalan P, Agarwal AK, Akinbami FO, et al. Improved prognosis of heart failure due to idiopathic dilated cardiomyopathy in children. Int J Cardiol. Jul 1 1998;65(2):125-8. [Medline].

  97. Venugopalan P, Agarwal AK, Worthing EA. Chronic cardiac failure in children due to dilated cardiomyopathy: diagnostic approach, pathophysiology and management [published correction appears in Eur J Pediatr. 2000;160(4):266]. Eur J Pediatr. Nov 2000;159(11):803-10. [Medline].

  98. Vijayalakshmi IB, Yavagal ST, Prabhudev N. Role of echocardiography in assessing the mechanism and effect of ramipril on functional mitral regurgitation in dilated cardiomyopathy. Echocardiography. Apr 2005;22(4):289-95. [Medline].

  99. Villard E, Duboscq-Bidot L, Charron P, et al. Mutation screening in dilated cardiomyopathy: prominent role of the beta myosin heavy chain gene. Eur Heart J. Apr 2005;26(8):794-803. [Medline].

  100. Weng KP, Lin CC, Huang SH, Hsieh KS. Idiopathic dilated cardiomyopathy in children: a single medical center's experience. J Chin Med Assoc. Aug 2005;68(8):368-72. [Medline].

  101. Werner B, Przybylski A, Kucinska B, et al. Implantable cardioverter-defibrillators in children. Kardiol Pol. Mar 2004;60(3):239-46. [Medline].

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Further Reading

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Keywords

dilated cardiomyopathy, DCM, congestive cardiomyopathy, idiopathic dilated cardiomyopathy, idiopathic cardiomyopathy, congestive cardiac failure, cardiac failure, heart failure, enlargement of the heart muscle, heart disease, global hypokinesia, fatigue, mitral regurgitation, tricuspid regurgitation, subendocardial ischemia,  ventricular arrhythmia, orthopnea, hemoptysis, frothy sputum, syncope, cardiomegaly, arrhythmia,  coxsackievirus B, human immunodeficiency, echovirus, rubella, varicella, mumps, Ebstein-Barr virus, cytomegalovirus, measles, poliovirus, diphtheria, Mycoplasma infection , tuberculosis, lyme disease, septicemia, psittacosis, Rocky Mountain spotted fever, Toxoplasma, Toxocara, Cysticercus, Histoplasma, coccidioidomycoses, Actinomyces, Duchenne muscular dystrophy, Becker muscular dystrophy, Friedreich ataxia, Kearns-Sayre syndrome, kwashiorkor, pellagra, thiamine deficiency, selenium deficiency, rheumatic fever, rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis, Kawasaki disease, thalassemia, sickle cell disease, iron deficiency anemia, anomalous left coronary artery from pulmonary artery, infarction, anthracycline, cyclophosphamide, chloroquine, iron overload, hypothyroidism, hyperthyroidism, hypoparathyroidism, pheochromocytoma, hypoglycemia, glycogen storage diseases, carnitine deficiency, fatty acid oxidation defects, mucopolysaccharidoses, Cat-cry syndrome

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Contributor Information and Disclosures

Author

Poothirikovil Venugopalan, MBBS, MD, FRCP (Glasg), FRCPCH, Consulting Staff, Department of Child Health, University Hospital of Hartlepool, UK
Poothirikovil Venugopalan, MBBS, MD, FRCP (Glasg), FRCPCH is a member of the following medical societies: British Cardiac Society and Royal College of Physicians and Surgeons of Glasgow
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey Allen Towbin, MD, MSc, FAAP, FACC, FAHA, Professor, Departments of Pediatrics (Cardiology), Cardiovascular Sciences, and Molecular and Human Genetics, Baylor College of Medicine; Chief of Pediatric Cardiology, Foundation Chair in Pediatric Cardiac Research, Texas Children's Hospital
Jeffrey Allen Towbin, MD, MSc, FAAP, FACC, FAHA is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American College of Cardiology, American College of Sports Medicine, American Heart Association, American Medical Association, American Society of Human Genetics, Cardiac Electrophysiology Society, Heart Rhythm Society, New York Academy of Sciences, Society for Pediatric Research, Texas Medical Association, and Texas Pediatric Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Ameeta Martin, MD, Clinical Associate Professor, Department of Pediatric Cardiology, University of Nebraska College of Medicine
Ameeta Martin, MD is a member of the following medical societies: American College of Cardiology
Disclosure: Nothing to disclose.

CME Editor

Gilbert Herzberg, MD, Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College
Gilbert Herzberg, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Chief Editor

Steven R Neish, MD, SM, Director of Pediatric Cardiology Fellowship Program, Associate Professor, Department of Pediatrics, Baylor College of Medicine
Steven R Neish, MD, SM is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, and American Heart Association
Disclosure: Nothing to disclose.

 
 
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