Overview
Definition
A disease of the heart muscle characterized by ventricular dilation and impaired systolic function.
Epidemiology
The most common type of cardiomyopathy. A leading indication for heart transplantation.
Etiology & Risk Factors
- Idiopathic (most common)
- Ischemic heart disease
- Viral myocarditis (Coxsackie B)
- Alcohol abuse / Toxins (Doxorubicin)
- Peripartum
Clinical Symptoms
- Progressive dyspnea on exertion
- Orthopnea
- Peripheral edema
- Fatigue
Clinical Approach
Diagnosis
- Echocardiogram (dilated ventricles with reduced ejection fraction)
- Chest X-ray (Cardiomegaly - balloon-like heart)
- Cardiac MRI (to differentiate etiology)
Management
- Guideline-directed medical therapy for HFrEF (Beta-blockers, ACEI/ARB/ARNI, Aldosterone antagonists, SGLT2 inhibitors)
- Treat underlying cause (stop alcohol, treat ischemia)
- ICD/CRT placement depending on EF and QRS duration
Complications
- Heart failure
- Thromboembolism (mural thrombus)
- Arrhythmias
- Death