Pediatric Dilated Cardiomyopathy Clinical Presentation

Updated: Jan 25, 2019
  • Author: Poothirikovil Venugopalan, MBBS, MD, FRCPCH; Chief Editor: Syamasundar Rao Patnana, MD  more...
  • Print


Onset is usually insidious but may be acute in as many as 25% of patients with dilated cardiomyopathy (DCM), especially if exacerbated by a complicating lower respiratory infection. Cough, poor feeding, irritability, and shortness of breath are usually the initial presenting symptoms. Pallor, sweating, easy fatigability, failure to gain weight, and decreased urine output may be observed. Wheezing may be an important clinical sign, suggesting congestive heart failure in infants.

Other symptoms at presentation, found in approximately 20% of patients, are as follows:

  • Chest pain

  • Palpitations

  • Orthopnea

  • Hemoptysis

  • Frothy sputum

  • Abdominal pain

  • Syncope

  • Neurologic deficit

Approximately 50% of patients with DCM have a history of preceding viral illness. A detailed family history for familial cardiomyopathy is revealing in as many as 25% of cases.


Physical Examination

In a patient with established disease, features of congestive heart failure are dominant.

The infant or young child with the disease is often tachypneic, tachycardic with weak peripheral pulses, and has cool extremities and hepatomegaly. Blood pressure is low, with a decreased pulse pressure. In extreme cases, patients may present in shock.

Older children may show dependent edema, elevated jugular venous pulses, and fine basal crepitations in the lungs.

Major cardiac findings include the following:

  • Cardiomegaly

  • Quiet precordium

  • Tachycardia

  • Gallop rhythm (S3 and/or S4)

  • Accentuated P-2

  • Murmurs of mitral and tricuspid regurgitation

Murmurs may be inconspicuous initially if the patient presents with acute heart failure.

Infants often present with predominantly respiratory signs and, in the absence of a precordial heave or prominent murmur, the underlying cardiac disease may remain undiagnosed until cardiomegaly is detected on a chest radiograph.