Cardiomyopathy, Idiopathic

• • 2 most common causes: dilated (idiopathic) and ischemic

  • Idiopathic

  • -Unknown etiology

    -Often multifactorial resulting in large, dilated heart with poor ventricular function

  • Ischemic

  • -Coronary artery disease causing severe ventricular dysfunction

    - See Cardiomyopathy, Ischemic.

Epidemiology

• • 60% of patients with NYHA Class IV disease will die within 1 year

  • Medical therapy for cardiomyopathy carries dismal prognosis

Symptoms and Signs

• • Heart failure symptoms

Laboratory Findings

• • ECG: Q waves, widened QRS, conduction defects

Imaging Findings

• • Chest film: Pulmonary congestion, enlarged heart

• • Echocardiography

  • Catheterization

Rule Out

• • Other causes of heart failure

• • Physical exam

  • ECG

  • Echocardiography

• • Idiopathic

  • -Cardiac transplantation may have best long-term results

    -Mitral valve annuloplasty if enlarged annular size from LV enlargement

    -Batista procedure: ventricular reduction; limited use

    -Biventricular pacing: Restores normal depolarization to ventricles, increasing ejection fraction significantly

  • Ischemic

  • -Consider coronary artery bypass grafting (CABG) if suitable target vessels and evidence of "hibernating" mycoardium

Surgery

Indications

• • CABG: If suitable target vessels, hibernating myocardium on PET scan or stress thallium

  • Idiopathic: Cardiac transplantation in suitable candidates

Prognosis

• • Batista procedure: Limited survival, high mortality

  • Medical therapy carries dismal prognosis

  • See Cardiomyopathy, Ischemic.

References