Dilated cardiomyopathy (DCM) is defined as left ventricular chamber dilation with decreased systolic dysfunction (FEVG <40%). There may also be right ventricular dysfunction. Causes are related to intrinsic myocardial damage.
There are dilated, thin walled, poorly contracting ventricles +/- atria
Although a variety of aetiologies can result in a dilated cardiomyopathy which are listed as below. Some are classified as separate entities. (See WHO 1995 classification of cardiomyopathies)
- ischaemic (coronary artery disease) - ischaemic cardiomyopathy
- infectious (myocarditis: virus, bacteria)
- infiltrative disease (sarcoid, amyloid)
- metabolic (uraemia, hypocalcemia, hypophosphataemia, thyrotoxicosis)
- toxic (alcohol, cocaine)
- chemotherapy (doxororubicin)
- others (peri-partum, muscular dystrophies)
- auto-immune cross reactivity (e.g. late onset cardiomyopathy in Chagas disease)
- idiopathic: idiopathic dilated cardiomyopathy
- familial : familial dilated cardiomyopathy 7
Chest radiographs commonly show enlarged left ventricle and atria with pulmonary oedema +/- pleural effusions.
The degree of left ventricular dilatation is highly variable and depends on the stage of disease and severity of left ventricular dysfunction.
- acute phase
- ventricle is just mildly dilated or may even be normal in size because compensatory dilatation has not yet developed.
- those with additional volume overload (mitral or aortic regurgitation) tend to have larger ventricles.
- chronic phase: with progressive dilatation the ventricle assumes a more spherical shape
The left ventricular wall is rather thin. However, as the left ventricle is enlarged, the total left ventricular mass may be increased.
In idiopathic dilated cardiomyopathy, the left heart is markedly dilated and thinned, and midwall enhancement especially in the septum is present in more than 50% of patients 4.
Late-enhancement MR images may demonstrate areas of fibrosis within the myocardium, characteristically in the mid- or subepicardial myocardium, allowing differentiation from ischaemic cardiomyopathy 6.
On plain radiographs consider:
- large pericardial effusion
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