Dilated Cardiomyopathy Clinical Presentation

Updated: Jan 20, 2017
  • Author: Vinh Q Nguyen, MD; Chief Editor: Henry H Ooi, MD, MRCPI  more...
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Presentation

History

Determine the severity of disease, possible causes (eg, alcohol or drug use), and symptoms 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 age, sex, race, and 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

For additional information on dilated cardiomyopathy from specific causes, see the Medscape Reference articles Alcoholic Cardiomyopathy, Cocaine-Related Cardiomyopathy, and Pregnancy and Cardiomyopathy.

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Physical Examination

On physical examination, look for signs of heart failure and volume overload. Assess vital signs with specific attention to the following:

  • Tachypnea
  • Tachycardia
  • Hypertension or hypotension

Other pertinent findings include the following:

  • Signs of hypoxia (eg, cyanosis, clubbing)
  • Jugular venous distension (JVD)
  • Pulmonary edema (crackles and/or wheezes)
  • S 3 gallop
  • Enlarged liver
  • Peripheral edema

The level of cardiac compensation (or decompensation) determines which signs are present.

Look for the following on examination of the neck:

  • Jugular venous distention (as an estimate of central venous pressure)
  • Hepatojugular reflux
  • a wave
  • Large cv wave (observed with tricuspid regurgitation)
  • Goiter

Heart examination

Palpate for heaves, shifted point of maximal impulse, and cardiomegaly (broad and displaced point of maximal impulse, right ventricular heave). The normal apical impulse should be approximately the size of a quarter and should be located in one (fourth or fifth) intercostal space. The apical impulse is normally within 10 cm of the midsternal line. In a person with dilated cardiomyopathy, the clinician may be able to palpate an apical presystolic impulse. Observe for signs of previous surgery.

Murmurs (with appropriate maneuvers), tachycardia, S2 at the base (paradoxical splitting, prominent P2), S3, and S4 may be noted. Remember that S3/S4 are low-frequency sounds heard best with the bell and that a prominent pulmonic component of the S2 audible at the apex can be misinterpreted as an S3 if care is not taken to distinguish the frequency of the sound. An irregularly irregular rhythm (atrial fibrillation) may be noted. Gallops may be present in persons with dilated cardiomyopathy.

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