Emergency: requires immediate attention
Dilated cardiomyopathy
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Synopsis

Dilated cardiomyopathies (DCM) represent a range of myocardial disorders characterized by left and right ventricular dilatation and reduced myocardial contractility. Prevalence is estimated at about 36 cases per 100 000. DCM typically presents at 30-60 years of age. African Americans have an almost 3-fold increased risk for developing DCM.
DCM may have an ischemic or nonischemic etiology. Nonischemic causes include inherited muscular disease, chemotherapy (eg, anthracyclines), endocrinopathies (eg, thyrotoxicosis, pheochromocytoma), infiltrative diseases (eg, amyloidosis), alcohol use disorder, and viral myocarditis. Genetic causes include mutations in genes encoding cardiac sarcomere and cytoskeletal proteins. Many cases are idiopathic.
Patients usually present with symptoms of heart failure including dyspnea, edema, orthopnea, and weight gain. Physical examination may reveal signs of acute left ventricular failure, such as S3 gallop, systolic murmur consistent with mitral regurgitation, pleural effusions, jugular venous distension, and/or peripheral edema.
DCM may have an ischemic or nonischemic etiology. Nonischemic causes include inherited muscular disease, chemotherapy (eg, anthracyclines), endocrinopathies (eg, thyrotoxicosis, pheochromocytoma), infiltrative diseases (eg, amyloidosis), alcohol use disorder, and viral myocarditis. Genetic causes include mutations in genes encoding cardiac sarcomere and cytoskeletal proteins. Many cases are idiopathic.
Patients usually present with symptoms of heart failure including dyspnea, edema, orthopnea, and weight gain. Physical examination may reveal signs of acute left ventricular failure, such as S3 gallop, systolic murmur consistent with mitral regurgitation, pleural effusions, jugular venous distension, and/or peripheral edema.
Codes
ICD10CM:
I42.0 – Dilated cardiomyopathy
SNOMEDCT:
399020009 – Congestive cardiomyopathy
I42.0 – Dilated cardiomyopathy
SNOMEDCT:
399020009 – Congestive cardiomyopathy
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Acute coronary syndrome
- Myocarditis
- Takotsubo syndrome
- Cocaine use disorder (ie, cocaine-related cardiomyopathy)
- Toxic cardiomyopathy (eg, alcoholic cardiomyopathy)
- Peripartum cardiomyopathy
- Tachycardia-mediated cardiomyopathy
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
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References
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Last Reviewed:11/14/2017
Last Updated:01/13/2022
Last Updated:01/13/2022