Dilated Cardiomyopathy

Cardiology (12%) Core Clinical Conditions

2B: The Physician Associate is able to undertake the day to day management of the patient and condition once the diagnosis and strategic management decisions have been made by another.

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Definition Aetiology Pathophysiology Risk factor Sign and Symptoms Investigations Management

Dilated cardiomyopathy is a medical condition in which the heart enlarges and weakens, impairing its ability to efficiently pump blood.

• Genetics.

• Viral infections: Some viruses can cause inflammation to the heart muscle

• Alcohol abuse.

• Other medical conditions: hypertension, thyroid disorders, diabetes, and obesity

• Chemotherapy treatment can lead to dilated cardiomyopathy.

• Idiopathic

1. Ventricular dilation: the left ventricle becomes enlarged and stretched, diminishing its capacity to contract and effectively pump blood.

2. Impaired contractility: The heart muscle becomes weakened and unable to contract with sufficient force to effectively pump blood, resulting in diminished cardiac output.

3. Valve dysfunction: As the heart muscle swells, the valves that regulate blood flow through the heart can become deformed and fail to close properly, causing blood to regurgitate back into the chambers.

4. Remodeling of the heart: Over time, the heart muscle's structure and function can undergo changes, resulting in further impairment of cardiac function.

• Family history.

• Viral infections: some viral infections particularly infections caused by enterovirus and adenovirus.

• Alcohol abuse.

• Other medical conditions: hypertension, diabetes, obesity, and thyroid disorders.

• Certain medications: immunosuppressants and some antipsychotics.

• Age: over 60s.

• Gender: men are more susceptible than women.

• Lifestyle factors: smoking, sedentary lifestyle, and poor diet.

• Weakness and weariness

• Breathlessness upon exertion or when lying flat

• Ankle / leg Swelling

• Chest pain (less often).

• Palpitations.

• Possible causes of vertigo are a drop in blood pressure or a decrease in cardiac output.

• Chronic coughing or wheezing, particularly at night, can be a sign of fluid accumulation in the lungs.

• Electrocardiogram (ECG): may display sinus tachycardia or a bundle branch block.

• Echocardiogram

• Chest X-ray: you will observe cardiomegaly and possible pulmonary oedema. 

• Cardiac MRI

• Blood tests: check kidney and liver function, B-type natriuretic peptide (BNP) can be requested also.

• Holter monitor: if patient present with palpitation symptoms

• Cardiac catheterization

• Medications: Angiotensin-converting enzyme (ACEi) inhibitors, beta-blockers, and diuretics can be used to improve cardiac function, reduce fluid accumulation, and regulate blood pressure.

• Lifestyle modifications: quitting smoking, reducing alcohol consumption, maintaining a healthy diet, and engaging in regular exercise, can aid in the management of dilated cardiomyopathy.

• Anticoagulants prescribed to patients with atrial fibrillation.

• Surgery: In severe cases, surgery may be required to remove or repair damaged heart tissue, or to implant a pacemaker or defibrillator.

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