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DilatedCardiomyopathy
DCMGUJunDept.of
CardiovascularMedicine
DilatedCardiomyopathy
DCMGUJ1Case
A36yearoldmancomestoyourofficecomplainingofthreemonthsofprogressivefatigueanddyspneaonexertion.Severaltimesinthepastmonthhehasawakenedfromsleepwithseverebreathlessnessandfeltaneedtositupinordertobreath.Hedeniesanychestpain.Hehasnopastmedicalhistoryofheartdisease,hypertensionordiabetes.Hisfamilyhistoryisnegativeforheartdisease.Hedoesnotsmokeanddrinksalcoholonlyrarely.Hetakesnomedications.Case2PhysicalExaminationBP105/70mmHg,P98regularLungs:rales.Heart:Enlargedheartborder. S1diminishedintensity,S2normal,S3ispresent. 2/6systolicmurmurattheapex.Abdomen:Liverisenlargedandslightlytender topressure.Extremities:Mildedemaofbothfeet.DilatedCardiomyopathy,DCMPhysicalExaminationBP105/70m3DefinitionHeartmuscledisorderEnlargedleftventricleorbothventriclesImpairedsystolic
pumpfunctionOftenwithmanifestationofheartfailureorarrhythmiaDefinitionHeartmuscledisorde4EpidemiologyAnnualincidence:5-10patientspermillionMale-femaleratio:2.5:1Averageageofincidence:40HigherincidenceinthedevelopingcountriesAnnualmortalityrate:25%-45%EpidemiologyAnnualincidence:5EtiologyNotclearFamilial/genetic(20%)
ViralinfectiousagentsandautoimmuneAcuteviral
myocarditis
canprogresstochronicdilatedcardiomyopathyChronichormonaldisordersUseofcertainsubstances,especiallyalcohol,cocaine,antidepressants,andchemotherapydrugsEtiologyNotclear6PathologyGrossexamination：
ThinnedventricularwallsEnlargedventriclesFibrinandscarMuralthrombus
NormalvalvesandcoronaryarteriesPathologyGrossexamination：7
DCMNormalDCM8Microscopicexamination:
Myocardialcellmaybehypertrophy,denaturation,fibrosisornecrosis.PathologyMicroscopicexamination:Pathol9PathophysiologyPumplessbloodforthebody'sneeds
HeartfailureMyocardialchangesinvolveconductionsystemArrhythmiaMuralthrombusfalloffEmbolismPathophysiologyPumplessblood10ClinicalManifestation
Symptoms：NosymptomintheearlystageFatigue,dyspnea,orthopneaAnorexia,edemaPalpitation,arrhythmia(Af,VT)Embolism(brain,lung,lowerextremity)Suddendeath(VT,embolism,bradycardia)ClinicalManifestationSymptom11ClinicalManifestation
Signs：CardiacdullnessextendstoleftanddownwardsRales,pleuraleffusionJugularvenousdistention,hepatomegaly,edemaGalloprhythm,S3,S4Systolicmurmurovertheapexarea(mitralinsufficiency)ClinicalManifestationSigns：12AccessoryExaminationChestX-rayEnlargementoftheheartSignsofpulmonarycongestionAccessoryExaminationChestX-r13AccessoryExaminationECGAtrialfibrillationConductionblockST-TchangesLow-voltageQRSPathologicQwaveVentricularprematureortachycardiaAccessoryExaminationECG14AccessoryExaminationAccessoryExamination15AccessoryExaminationEchocardiographyDilatedleftventricleorbothventriclesRelativemitral/tricuspidinsufficiencyduetodilatedleft/rightventricleVentricularwallsnotthickPoorlycontractileleftventricleEF<50%AccessoryExaminationEchocardi16AccessoryExaminationCoronaryangiography:UsuallynormalCardiacbiopsy:Fibrosisormyocardialcelluarhypertrophy,denaturationornecrosisAccessoryExaminationCoronary17Excludeotherheartdiseases
DilatedheartArrhythmiaHeartfailure
Echo:dilated&poorlycontractileventricleCoronary/Rheu-matic/HypertensiveheartdiseaseDiagnosisSpecificcardiomyopathy
EXCLUDEDiagnosisExcludeotherheartdiseasesDi18DCMIschemiccardiomyopathyICMAgeHistoryOfteninmiddleage，<40yearsoldOfteninoldage，>40yearsoldMyocarditis,Nohistoryofangina
RiskfactorsofCHD,historyofanginaormyocardialinfarctionDifferentialdiagnosisDCMIschemiccardiomyopathyAgeH19DCMICMEchoOftenfourchambersdilated，theweakmovementofwholeheart,muralthrombusinsomepatientsOftenonlyleftventricledilated,segmentalmovementabnormality，ventricularaneurysminsomepatients
Angio-graphyNormalMultivesseldiseaseDifferentialdiagnosisDCMICMEchoOften20TreatmentGeneraltreatmentDecreasedactivityandbedrestSaltrestrictionStopalcoholNutritionalsupportTreatmentGeneraltreatment21TreatmentTreatmentofheartfailureDigitalisDiureticsVasodilatorsACEI(angiotensinconvertingenzymeinhibitors)ARB(angiotensin
receptorblockers)TreatmentTreatmentofheartfa22TreatmentAntiarrhythmictreatmentBetablockers(startwithlow-dose,increasedosegradually)AmiodaronePacemakerimplantationICD(implantablecardioverterdefibrillator)TreatmentAntiarrhythmictreatm23TreatmentCRT(CardiacResynchronizationTherapy)Surgery:hearttransplantationTreatmentCRT(CardiacResynchr24QuestionsWhatareechocardiographicfindingsinDCM?HowtodistinguishbetweenDCMandICM?HowtotreatDCM?QuestionsWhatareechocardiogr25心肌病(心內(nèi)科)課件26DilatedCardiomyopathy
DCMGUJunDept.of
CardiovascularMedicine
DilatedCardiomyopathy
DCMGUJ27Case
A36yearoldmancomestoyourofficecomplainingofthreemonthsofprogressivefatigueanddyspneaonexertion.Severaltimesinthepastmonthhehasawakenedfromsleepwithseverebreathlessnessandfeltaneedtositupinordertobreath.Hedeniesanychestpain.Hehasnopastmedicalhistoryofheartdisease,hypertensionordiabetes.Hisfamilyhistoryisnegativeforheartdisease.Hedoesnotsmokeanddrinksalcoholonlyrarely.Hetakesnomedications.Case28PhysicalExaminationBP105/70mmHg,P98regularLungs:rales.Heart:Enlargedheartborder. S1diminishedintensity,S2normal,S3ispresent. 2/6systolicmurmurattheapex.Abdomen:Liverisenlargedandslightlytender topressure.Extremities:Mildedemaofbothfeet.DilatedCardiomyopathy,DCMPhysicalExaminationBP105/70m29DefinitionHeartmuscledisorderEnlargedleftventricleorbothventriclesImpairedsystolic
pumpfunctionOftenwithmanifestationofheartfailureorarrhythmiaDefinitionHeartmuscledisorde30EpidemiologyAnnualincidence:5-10patientspermillionMale-femaleratio:2.5:1Averageageofincidence:40HigherincidenceinthedevelopingcountriesAnnualmortalityrate:25%-45%EpidemiologyAnnualincidence:31EtiologyNotclearFamilial/genetic(20%)
ViralinfectiousagentsandautoimmuneAcuteviral
myocarditis
canprogresstochronicdilatedcardiomyopathyChronichormonaldisordersUseofcertainsubstances,especiallyalcohol,cocaine,antidepressants,andchemotherapydrugsEtiologyNotclear32PathologyGrossexamination：
ThinnedventricularwallsEnlargedventriclesFibrinandscarMuralthrombus
NormalvalvesandcoronaryarteriesPathologyGrossexamination：33
DCMNormalDCM34Microscopicexamination:
Myocardialcellmaybehypertrophy,denaturation,fibrosisornecrosis.PathologyMicroscopicexamination:Pathol35PathophysiologyPumplessbloodforthebody'sneeds
HeartfailureMyocardialchangesinvolveconductionsystemArrhythmiaMuralthrombusfalloffEmbolismPathophysiologyPumplessblood36ClinicalManifestation
Symptoms：NosymptomintheearlystageFatigue,dyspnea,orthopneaAnorexia,edemaPalpitation,arrhythmia(Af,VT)Embolism(brain,lung,lowerextremity)Suddendeath(VT,embolism,bradycardia)ClinicalManifestationSymptom37ClinicalManifestation
Signs：CardiacdullnessextendstoleftanddownwardsRales,pleuraleffusionJugularvenousdistention,hepatomegaly,edemaGalloprhythm,S3,S4Systolicmurmurovertheapexarea(mitralinsufficiency)ClinicalManifestationSigns：38AccessoryExaminationChestX-rayEnlargementoftheheartSignsofpulmonarycongestionAccessoryExaminationChestX-r39AccessoryExaminationECGAtrialfibrillationConductionblockST-TchangesLow-voltageQRSPathologicQwaveVentricularprematureortachycardiaAccessoryExaminationECG40AccessoryExaminationAccessoryExamination41AccessoryExaminationEchocardiographyDilatedleftventricleorbothventriclesRelativemitral/tricuspidinsufficiencyduetodilatedleft/rightventricleVentricularwallsnotthickPoorlycontractileleftventricleEF<50%AccessoryExaminationEchocardi42AccessoryExaminationCoronaryangiography:UsuallynormalCardiacbiopsy:Fibrosisormyocardialcelluarhypertrophy,denaturationornecrosisAccessoryExaminationCoronary43Excludeotherheartdiseases
DilatedheartArrhythmiaHeartfailure
Echo:dilated&poorlycontractileventricleCoronary/Rheu-matic/HypertensiveheartdiseaseDiagnosisSpecificcardiomyopathy
EXCLUDEDiagnosisExcludeotherheartdiseasesDi44DCMIschemiccardiomyopathyICMAgeHistoryOfteninmiddleage，<40yearsoldOfteninoldage，>40yearsoldMyocarditis,Nohistoryofangina
RiskfactorsofCHD,historyofanginaormyocardialinfarctionDifferentialdiagnosisDCMIschemiccardiomyopathyAgeH45DCMICMEchoOften
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