Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content + • 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 ++Braile DM et al. Dynamic cardiomyoplasty: long-term clinical results in patients with dilated cardiomyopathy. Ann Thorac Surg. 2000;69:1445. [PubMed: 10881820] ++Bardy GH et al: Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 2005;352:225. [PubMed: 15659722] ++Cleland JG et al: The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 2005;352:1539. [PubMed: 15753115] ++Dargie HJ: Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: The CAPRICORN randomised trial. Lancet 2001;357:1385. [PubMed: 11356434] ++Hunt SA et al: ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adultâsummary article. Circulation 2005;112:1825. GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessSurgery 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessSurgery Full Site: One-Year Individual Subscription $995 USD Buy Now View All Subscription Options