Presentation
Patient will present as → a 28-year-old Caucasian female complaining of a one-week history of fatigue, progressively worsening shortness of breath, and swelling of her feet and ankles. She denies any chest pain. Her past medical history is unremarkable except for a recent cold two weeks prior to this presentation. She denies any past surgical history. She takes oral contraceptive pills as her only medication. She denies any recreational drug use. On physical exam, her temperature is 37 C (98.6 F), blood pressure is 120/70 mmHg, pulse is 84/min, and respiratory rate is 20/min. Her physical exam is also notable for bibasilar crackles, jugular venous distension, an S3 gallop (heard below), and 2+ pitting edema up to the ankles bilaterally. Her electrolytes and complete blood count are within normal limits. CXR reveals cardiomegaly with pulmonary congestion, EKG shows nonspecific ST and T wave changes, and echocardiography demonstrates left ventricular dilation and dysfunction and low cardiac output.
Pearls
Dilated cardiomyopathy is the most common type (95%) of cardiomyopathy and is a condition in which an index event or process damages the myocardium, weakening the heart muscle resulting in reduced strength of ventricular contraction, and dilation of all four chambers of the heart
- Causes include viral infections, genetic abnormalities (25% to 30%), hypertension, excessive alcohol consumption, postpartum state, chemotherapy toxicity, endocrinopathies, and myocarditis; it may also be idiopathic
- Dilated cardiomyopathy is characterized by a reduced strength of contraction and systolic dysfunction. The result is right and/or left ventricular enlargement and progressive heart failure with increased risk for sudden cardiac death
- Dilated cardiomyopathy is systolic heart failure (S3 heart sound and low ejection fraction). Will present with acute onset or slowly progressive symptoms
- Symptoms include exertional dyspnea, edema, fatigue, loss of appetite, and cough
Diagnosis
Echocardiography is the most definitive diagnosis – demonstrates left ventricular dilation and dysfunction and low cardiac output with poor EF (< 50%, but often less than 30%)
- EKG will show nonspecific ST/T wave changes
- Physical Exam will reveal classic signs of CHF: swelling in legs, lung sounds, and Elevated jugular venous pressure (JVP). Along with cardiomegaly (displaced apical impulse), S3 gallop (third heart sound), and an enlarged liver
- CXR often shows a balloon-like heart – and will show cardiomegaly and pulmonary congestion
Treatment
Treat just like systolic heart failure
- βblocker + ACE + Loop Diuretic
- Increase cardiac contractility – Digitalis
- Treatment in extreme cases includes heart transplant or left ventricular assist device
Flashcards
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