0071643192.pdf

CAUSES

The vast majority of cases are idiopathic, but known causes include:

■ Peripartum
■ Most common in first two months postpartum but can occur between
last month of pregnancy and first six months postpartum
■ More common in older multiparous women and twin gestations
■ 50% will have complete resolution.
■ Heavy alcohol use
■ Heavy cocaine use
■ Viral myocarditis
■ Amyloidosis: Can also cause restrictive cardiomyopathy
■ CAD
■ Hypothyroidism and hyperthyroidism

PATHOPHYSIOLOGY

■ Myocardial cell death and fibrosis →cardiac chamber dilatation and systolic
dysfunction

SYMPTOMS

■ Dyspnea
■ Fatigue
■ Palpitations
■ Lower extremity swelling

EXAM

■ Rales
■ Laterally displaced point of maximal impulse (PMI)
■ Jugular venous distention
■ Peripheral edema

DIAGNOSIS

■ ECG is nonspecific, but may include
■ Left atrial enlargement
■ Left ventricular hypertrophy
■ Conduction abnormalities
■ Atrial fibrillation
■ CXR
■ “Globular” enlarged heart
■ Pulmonary edema
■ Echocardiogram demonstrates four-chamber enlargement and impaired
LV function.

TREATMENT

■ Supportive therapy
■ ACE inhibitors
■ Provide afterload reduction
■ Reduce morbidity and mortality
■ Alternative (if ACE inhibitor contraindicated) = combination of
hydralazine and nitrates
■ β-Blockers: Improve survival
■ Diuretics and digitalis: Improve symptoms, but not survival
■ AICD placement
■ Anticoagulation
■ Severe cases require transplantation.

CARDIOVASCULAR EMERGENCIES

Amyloidosis can cause a

dilated or a restrictive

cardiomyopathy.

Diuresis and digoxin improve

symptoms in dilated

cardiomyopathy, but do not

improve survival.