In dilated cardiomyopathy the left ventricle becomes enlarged and weak, so the ejection fraction falls and heart failure develops. Causes include genes, alcohol, viral myocarditis, some chemotherapy drugs, pregnancy and long-lasting fast heart rates, though often no cause is found.
Key symptoms
- Shortness of breath with effort or lying flat
- Fatigue and less exercise tolerance
- Leg swelling
- Palpitations
- Fainting
What you find on exam
- Displaced, diffuse apical impulse
- Third heart sound; murmur of mitral regurgitation
- Raised jugular venous pressure and lung crackles
- Leg edema
- Signs of alcohol use or other causes
Tests
- Echocardiogram: dilated left ventricle with low ejection fraction
- ECG and Holter monitor for arrhythmias
- BNP, thyroid tests, iron studies, HIV test, kidney function
- Coronary angiography or CT to rule out ischemic disease
- Cardiac MRI; genetic testing if there is a family history
Treatment basics
- Core heart failure medicines: sacubitril-valsartan, beta blocker, spironolactone, SGLT2 inhibitor
- Loop diuretic for fluid
- Stop alcohol and drugs that harm the heart
- ICD to prevent sudden death; CRT if the QRS is wide
- Anticoagulation if atrial fibrillation; heart transplant for end-stage disease
Red flags
- Fainting or sustained ventricular tachycardia
- Breathlessness at rest
- Low blood pressure with cold limbs
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.