Cardiomyopathy, Dilated

Accounts for approximately ∼10,000 deaths and ∼46,000 hospitalizations per year in USA; idiopathic DCM is one of the primary indications for cardiac transplantation.

Often ages ∼20–60 y old but can affect older and younger pts as well.

African-Americans > Caucasians; males > females

CHF and dysrhythmias and hemodynamic instability.

Morbidity and mortality directly related to severity of cardiomyopathy and complexity of surgery.

Compromised myocardial function and hemodynamic instability.

Management strategies periop include pharmacologic and mechanical support options.

Dysrhythmias and management of CRT/ICD devices.

Meticulous assessment and management of periop volume status.

DCM is characterized by myocyte death and fibrosis, leading to impaired myocardial contraction, chamber dilatation, and LV and/or RV failure.

Dilation and diminished systolic function (EF <40%) lead to heart failure, often manifesting initially with dysrhythmias or sudden cardiac death.

Presentation and clinical course varies tremendously, but pts are commonly found to have symptoms of heart failure with diminished exercise tolerance and dyspnea, orthopnea, and PND.

Discovery of cardiomegaly on physical exam or CXR or ECHO may also lead to the diagnosis or may present with dysrhythmias, conduction delays, or sudden death.

Sx are often gradual in onset and initially underappreciated until cardiac function is notably compromised, although it may present more acutely depending on etiology.

The clinical course is variable from gradual deterioration to rapid decline.

Diagnostic evaluation begins with a thorough history and physical exam and progresses to include lab testing and ECG, ECHO, coronary angiography, and endomyocardial biopsy.

Assessment of myocardial function and reserve are important in guiding periop management.

50% of cases are idiopathic, ∼9% myocarditis, and ∼7% ischemic; others include infiltrative, peripartum, Htn, HIV, connective tissue disease, toxins including substance abuse, ETOH, doxorubicin, endocrinopathies, genetic diseases, and multiple others, although in lesser frequency. Interestingly, genetic abnormalities are being increasingly recognized.