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Sections Dilated Cardiomyopathy
- Overview
- Presentation
- DDx
- Workup
- Treatment
- Approach Considerations
- Blood Pressure Control
- ACE Inhibitors and ARBs
- Beta Blockers
- Aldosterone Antagonists
- Cardiac Glycosides
- Diuretics
- Antiarrhythmics
- Vasodilators
- Human B-Type Natriuretic Peptide
- Inotropic Agents
- Anticoagulation
- Left Ventricular Assist Devices
- Cardiac Resynchronization Therapy (Biventricular Pacing)
- Automatic Implantable Cardioverter-Defibrillators
- Heart Transplantation
- Diet and Activity
- Cardiac Rehabilitation
- Investigational Therapy for Heart Failure
- Consultations
- Show All
- Medication
- Questions & Answers
- References
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:
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Fatigue
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Dyspnea on exertion, shortness of breath
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Orthopnea, paroxysmal nocturnal dyspnea
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Increasing edema, weight, or abdominal girth
Note other important patient information, including age, sex, race, and medical history, especially the following:
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Hypertension
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Angina
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Coronary artery disease
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Anemia
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Thyroid dysfunction
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Breast cancer
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Prior history of heart failure or myocardial injury
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Medications (especially new medications or lack of compliance with current medications)
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Social history (eg, tobacco, alcohol, illicit drug use)
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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.
Physical Examination
On physical examination, look for signs of heart failure and volume overload. Assess vital signs with specific attention to the following:
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Tachypnea
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Tachycardia
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Hypertension or hypotension
Other pertinent findings include the following:
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Signs of hypoxia (eg, cyanosis, clubbing)
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Jugular venous distension (JVD)
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Pulmonary edema (crackles and/or wheezes)
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S3 gallop
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Enlarged liver
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Peripheral edema
The level of cardiac compensation (or decompensation) determines which signs are present.
Look for the following on examination of the neck:
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Jugular venous distention (as an estimate of central venous pressure)
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Hepatojugular reflux
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a wave
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Large cv wave (observed with tricuspid regurgitation)
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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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Tables
Vinh Q Nguyen, MD, FACC Assistant Professor of Cardiology, Baylor Scott and White Health-Temple
Vinh Q Nguyen, MD, FACC is a member of the following medical societies: American College of Cardiology, American Society of Echocardiography, Society for Cardiovascular Magnetic Resonance, Society of Cardiovascular Computed Tomography
Disclosure: Nothing to disclose.
Murat M Celebi, MD Clinical Assistant Professor of Medicine, Louisiana State University School of Medicine in New Orleans; Consulting Staff, Crescent City Cardiovascular Associates
Murat M Celebi, MD is a member of the following medical societies: American College of Cardiology, Louisiana State Medical Society, Heart Rhythm Society, Orleans Parish Medical Society
Disclosure: Nothing to disclose.
Amer Suleman, MD Private Practice
Amer Suleman, MD is a member of the following medical societies: American College of Physicians, Society for Cardiovascular Angiography and Interventions, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine
Disclosure: Nothing to disclose.
Gary Edward Sander, MD, PhD, FACC, FAHA, FACP, FASH Professor of Medicine, Director of CME Programs, Team Leader, Root Cause Analysis, Tulane University Heart and Vascular Institute; Director of In-Patient Cardiology, Tulane Service, University Hospital; Visiting Physician, Medical Center of Louisiana at New Orleans; Faculty, Pennington Biomedical Research Institute, Louisiana State University; Professor, Tulane University School of Medicine
Gary Edward Sander, MD, PhD, FACC, FAHA, FACP, FASH is a member of the following medical societies: Alpha Omega Alpha, American Chemical Society, American College of Cardiology, American College of Chest Physicians, American College of Physicians, American Federation for Clinical Research, American Federation for Medical Research, American Heart Association, American Society for Pharmacology and Experimental Therapeutics, American Society of Hypertension, American Thoracic Society, Heart Failure Society of America, National Lipid Association, Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.
Gyanendra K Sharma, MD, FACC, FASE Professor of Medicine and Radiology, Director, Adult Echocardiography Laboratory, Section of Cardiology, Medical College of Georgia at Augusta University
Gyanendra K Sharma, MD, FACC, FASE is a member of the following medical societies: American Association of Cardiologists of Indian Origin, American Association of Physicians of Indian Origin, American College of Cardiology, American Society of Echocardiography, Society for Cardiovascular Magnetic Resonance, Society of Cardiovascular Computed Tomography
Disclosure: Nothing to disclose.
Vivek J Goswami, MD Director of Nuclear Cardiology, Austin Heart; Clinical Assistant Professor, Texas A&M Health Science Center College of Medicine
Vivek J Goswami, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians-American Society of Internal Medicine, American Heart Association, American Medical Association, Illinois State Medical Society
Disclosure: Nothing to disclose.
Frank E Wilklow, MD Principal Investigator, Sub-Investigator, Cardiovascular Research Lab, Louisiana State University Health Sciences Center; Principal Investigator, Sub-Investigator, Gulf Regional Research and Education
Frank E Wilklow, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians
Disclosure: Nothing to disclose.
Uche A Blackstock, MD Staff Physician, Department of Emergency Medicine, Kings County Hospital Center, State University of New York Downstate
Disclosure: Nothing to disclose.
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.
Robert E Fowles, MD Clinical Professor of Medicine, University of Utah College of Medicine; Consulting Staff, Intermountain Medical Center and LDS Hospital; Director and Consulting Staff, Department of Cardiology, Salt Lake Clinic
Robert E Fowles, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, and American Heart Association
Disclosure: Nothing to disclose.
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.
Heather Murphy-Lavoie, MD, FAAEM Assistant Professor, Section of Emergency Medicine and Hyperbaric Medicine, Louisiana State University School of Medicine in New Orleans; Clinical Instructor, Department of Surgery, Tulane University School of Medicine
Heather Murphy-Lavoie, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine, and Undersea and Hyperbaric Medical Society
Disclosure: Nothing to disclose.
Ronald J Oudiz, MD, FACP, FACC, FCCP Professor of Medicine, University of California, Los Angeles, David Geffen School of Medicine; Director, Liu Center for Pulmonary Hypertension, Division of Cardiology, LA Biomedical Research Institute at Harbor-UCLA Medical Center
Ronald J Oudiz, MD, FACP, FACC, FCCP is a member of the following medical societies: American College of Cardiology, American College of Chest Physicians, American College of Physicians, American Heart Association, and American Thoracic Society
Disclosure: Actelion Grant/research funds Clinical Trials + honoraria; Encysive Grant/research funds Clinical Trials + honoraria; Gilead Grant/research funds Clinical Trials + honoraria; Pfizer Grant/research funds Clinical Trials + honoraria; United Therapeutics Grant/research funds Clinical Trials + honoraria; Lilly Grant/research funds Clinical Trials + honoraria; LungRx Clinical Trials + honoraria; Bayer Grant/research funds Consulting
Charles Preston, MD Clinical Associate Professor, Department of Medicine, Section of Emergency Medicine, Charity Hospital, Louisiana State University
Charles Preston, MD is a member of the following medical socities: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.
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.
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Medscape Reference Salary Employment
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Sections Dilated Cardiomyopathy
- Overview
- Presentation
- DDx
- Workup
- Treatment
- Approach Considerations
- Blood Pressure Control
- ACE Inhibitors and ARBs
- Beta Blockers
- Aldosterone Antagonists
- Cardiac Glycosides
- Diuretics
- Antiarrhythmics
- Vasodilators
- Human B-Type Natriuretic Peptide
- Inotropic Agents
- Anticoagulation
- Left Ventricular Assist Devices
- Cardiac Resynchronization Therapy (Biventricular Pacing)
- Automatic Implantable Cardioverter-Defibrillators
- Heart Transplantation
- Diet and Activity
- Cardiac Rehabilitation
- Investigational Therapy for Heart Failure
- Consultations
- Show All
- Medication
- Questions & Answers
- References
