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Dilated Cardiomyopathy - ECAB

Dilated Cardiomyopathy - ECAB

Ashok Seth


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Book Details


Dilated cardiomyopathy (DCM) is traditionally referred to as idiopathic dilated cardiomyopathy (IDC), which includes genetic forms of DCM.

The patients present with a wide range of symptoms like dyspnea, orthopnea, paroxysmal nocturnal dyspnea, arrhythmias or complications associated with DCM.

The diagnosis is based on exclusion of the various identifiable causes of systolic left ventricular dysfunction, such as ischemic cardiomyopathy, hypertensive cardiomyopathy, alcoholic cardiomyopathy, myocarditis secondary to viral or other causes, peripartum cardiomyopathy and cardiomyopathies secondary to amyloidosis, hemochromatosis, sarcoidosis, and due to drug toxicity.

The sophisticated and expensive diagnostic tests might not be feasible for a typical Indian patient. This prompts us to emphasize the need for corroborating the clinical clues with the available affordable investigative tests that also offer reasonably valid results.

The medical management of congestive heart failure is vital to the management protocol of DCM. The roles of heart transplant, cardiomyoplasty and surgical devices have to be weighed from patient to patient with a clear understanding of the etiology of the disease. The recent improvement in the prognosis of DCM presents an encouraging picture to the researchers and practitioners dedicated to the development of drugs and devices to improve the life expectancy of patients of DCM.

This clinical update module has been formulated to update the readers on the existing and emerging treatment strategies widely followed and recommended by practitioners of international repute. The essential features of the medical and surgical management have been discussed in detail. Moreover, a comprehensive discussion on the occurrence and management of DCM in pediatric patients has also been incorporated in this book. The book is an honest attempt to provide the medical practitioner with a wide knowledge platform about DCM and its clinical implications.

Table of Contents

Section Title Page Action Price
Front Matter Front Cover
Elsevier Clinical Advisory Board:Cardiology ic
Copyright ie
About the Authors if
Contents 1
ECAB Clinical Update Information i
Preface vi
Dilated Cardiomyopathy 1a
Definition 2
Incidence and Prevalence 2
Etiopathogenesis 2
Familial and Genetic Factors 3
Viral Myocarditis and other Cytotoxic Insults 3
Immune Abnormalities 4
The Role of the Sympathetic Nervous System 4
Pathology 5
Natural History 5
Clinical Presentation 6
History and Physical Examination 6
Diagnostic Testing 8
General Investigations 8
Specific Investigations 9
Chest X-ray PA and Lateral View 9
Electrocardiogram 10
Echocardiogram 10
Assessment of Ventricular Dyssynchrony 11
Metabolic Exercise Testing 11
Coronary Angiogram 13
Magnetic Resonance Imaging 14
Endomyocardial Biopsy 14
Iron Studies 14
HIV Assay 14
Prognosis 14
Factors Associated with Adverse Prognosis 15
Management of Dilated Cardiomyopathy 15
Lifestyle Management 16
Medical Management 16
Lifestyle Changes 16
Pharmacological Therapy 17
Management of Heart Failure 17
Mechanical Devices 23
Intracardiac Defibrillators 23
Cardiac Resynchronization Therapy 23
Investigational Treatments 25
Percutaneous Heart Valve Repair 25
Implantable Sensors 25
Case Studies Dilated Cardiomopathy 30
Case 1 30
On Examination 30
Investigations 30
Management 31
Diagnosis 31
Plan 31
Case 2 32
On Examination 32
Investigations 32
Diagnosis 35
Plan 35
Case 3 35
On Examination 35
Investigations 35
Diagnosis 37
Case 4 38
On Examination 38
Investigations 38
Diagnosis 39
Dilated Cardiomopathy in Children 40a
Introduction 40
Dilated Cardiomyopathy 40
Diagnostic Approach for Dilated Cardiomyopathy in Children 44
History and Physical Examination 48
Chest X-ray 49
EKG 50
Echocardiography 52
Metabolic and Genetic Work-up 54
Muscle Enzyme Assays 45
Endomyocardial Biopsy 56
Viral Studies 57
Screening Family Members 57
Treatment 58
Supportive Treatment 59
Digoxin and Diuretics 59
Intravenous Inotropes and Vasodilators 59
Angiotensin Converting Enzyme (ACE) Inhibitors 59
Beta-blockers and Carvedilol 60
Anticoagulation and Aspirin 61
Etiology-Specific\" Treatment 62
L-carnitine 62
Immunoglobulins 63
Immunosuppressive Treatment 63
Surgical Options for the Treatment of End-stage Heart Disease 63
Reduction Cardiomyoplasty 63
Assist Devices and Artificial Heart 63
Transplantation 64
Management of Extreme Heart Failure and Cardiogenic Shock 64
Initial Treatment 65
Pharmacologic Support 65
Inotropes 65
Phosphodiesterase Inhibitors 66
Vasodilators 66
Support of Vital Organ Function 67
Ventilatory Support 67
Support of Renal Function 67
Gastrointestinal and Nutritional Support 68
Management of Associated Infection 68
Prognosis of Dilated Cardiomyopathy 68
Conclusions 69
Case Study Dilated Cardiomopathy in Children 75
Clinical Case 75
Dilated Cardiomyopathy in Children: Management Algorithms 77
Surgical Treatment of Dilated Cardiomyopathy 83b
Treatment Options for Dilated Cardiomyopathy 84
Management of Dilated Cardiomyopathy 84
Surgical Treatment of Dilated Cardiomyopathy 85
Dynamic Cardiomyoplasty 85
Ventricular Reduction Surgery (Partial Left Ventriculectomy/Batista Procedure) 86
Ventricular Assist Devices 88
Heart Transplantation 89
Total Artificial Heart 90
Stem Cell Therapy for Cardiomyopathy 91
Summary 95
Forthcoming Books 97