Dilated cardiomyopathy Dilated cardiomyopathy (DCM) is a heart muscle disease that causes the heart's chambers to enlarge and the muscle walls to thin and weaken. It's the most common type of cardiomyopathy. DCM affects the heart's ventricles and atria, often starting in the left ventricle, the main pumping chamber. As the heart chambers dilate, the muscle can't contract normally and pumping blood becomes difficult.

1. DILATED CARDIOMYOPATHY
PAVANI.V
MSC .ECHOCARDIOGRAPHY

2. INTRODUCTION
 Cardiomyopathy is a group of disease that affect the
heart muscle(myocardium)
 This is characterized by left & right ventricular
dilatation and decreased myocardial contractility
 Heart failure due to systolic dysfunction charaterized
by reduction ejection fraction <40

3. IMAGE :

4. DEFINITION:
 The dilated cardiomyopathy (DCM) is defined as
an left ventricular dilatation and LV systolic
dysfunction in the absence of significant CAD
 DCM is aslo known as congestive
cardiomyopathy.

5. Causes:
 Infectious cardiomyopathy
-Viral cardiomyopathy
- Chagas disease (parasite trypanosoma cruzi)
- Lyme disease ( borrelia bacteria)
-Genetic causes of dilated cardiomyopathy
- Toxic causes of cardiomyopathy.
– Drugs: Alcohol, cocaine
– Medications: Chemotherapeutic agents
((anthracycline
anetroviral drugs

6. Cont..
 Metabolic disorder such as obesity, thyroid disease or
diabetic mellitus
 Lack of vitamins or minerals in your diet, such as
thaimin (vitamin B- 1)
 Pregnancy complication
 Iron buildup in heart muscel(Hemochromatosis)
 The growth of tiny lumps of inflammatory cells
(granulomas) in any part of body,including heart and
lungs (sacoidosis)
 The buildup of abnormal proteins in the organs
(Amyloidosis)

7. Types of cardiomypathy:
 Dilated cardiomyopathy
 Hypertrophic cardimyopathy
 Ischemic cardiomyopathy
 Restrictive cardiomyopathy
 Arrhythmogenic right ventricular dysplasia
 Broken heart syndrome( stress induced or
takotsubo cardiomyopathy)
 peripartum cardiomyopathy

8. PATHOPHYSIOLOGY
Due to above causes
Inflammation and rapid degeneration of myocardial
fibers results in ventricular dilation
Blood flow is stagnant or slow in an area in the chambers
of dilated heart
Vetricular ability to pump reduced significantly (Heart
failure)

9. cont...
Atrial enlargement
Decrease blood flow , blood clot formation
Systemic embolization
Heart failure,stoke,conduction
abnormalities

10. Clinical manifestation:
 Dyspnea, Plapitation
 peripheral edema
 Ascites
 Hepatomegaly
 Jugular venous distension
 Kussmaul signs
 Abdominal bloating, Nausea
 Weak peripheral pulse
 S3 gallop sound heard

11. INVESTIGATION:
 BLOOD TEST:
 BNP or NT- pro BNP
 Troponin
To rule out other causes
CBC
Renal function
Liver function
Thyroid function
Iron level
Serum ACE

12. cont...
 CHEST X RAY:
 Massive cardiomegaly
 water bottle shape heart
 Pleural effusion
 ECG FINDINGS:
 sinus tachycardia
 ST -T changes and Q wave present
 left bundle branch block
 Wide QRS complex > 120 sec
 Atrial fibrillation

13. cont...
 CARDIAC MRI:
 Without contrast demonstration markely dilated
left ventricle with thinned myocardium.

14. cont...
 ECHO FINDINGS:
 Left Ventricular Dilatation:
 Assessment of left ventricular internal dimension
(LVID) in diastole of > 60mm
 Left ventricular diastolic volumes f 198 ml
 Functional MR
 Left ventricular thrombus and spontaneous echo
contrast
(SEC)
 LVEF: M-mode: EPSS and B-hump

15. cont....
 Left Atrial Dilatation:
 Left atrial dimensions (indicator of raised left atrial filling
pressures)
 Stasis of blood in left atrium
 LV Diastolic Dysfunction:
 Mitral E/A Ratio (Response to Valsalva)
 Restrictive pattern indicates poor prognosis
 Deceleration Time
 Annular Doppler Tissue Velocity
E/e’
 EPSS = E point septal separation; LVEF = Left ventricular
ejection fraction

16. M-MODE & A4C

17. A4C

18. MEDICAL MANAGEMENT:
 LOWER YOUR BLOOD PRESSURE: ACE
inhibitors,Angiotensin II receptor blockers,Beta
blockers and Calcium channel blockers are
examples of medicines that lower blood
pressure.
 SLOW YOUR HEART RATE:Beta
blockers,Calcium channel blockers,Digoxin are
examples of medicine that slow the heart rate.
 KEEP YOUR HEART BEATING WITH A
NORMAL RHYTHM:These medicines,called
antiarrhythmic, help prevent arrhythmias
(irregular rhythm)

19. cont..
 REMOVE EXCESS FLUID AND SODIUM FROM
BODY: Diuretics or “water pills”, are example of
a medicine that helps remove excess fluid and
sodium from the body.
 PREVENT BLOOD CLOTS FROM FORMING:
Anticoagulant or blood thiner, help to prevent
blood clot. Blood thinner often are used to
prevent blood clod forming in dilated
cardiomypathy
 REDUCE INFLAMMATION: Medication used to
reduce inflammation include corticosteroids.

20. SURGICAL MANAGEMENT:
 Biventricular pacemaker
 Implantable cardioverter defibrillator
 left ventricular assist device

21. COMPLICATION:
 Heart failure
 Arrhythmias
 Blood clot
 Heart valve disease(eg: mitral regurgitation)
 cardiac arrest and sudden death

22. THANK YOU