Dilated Cardiomyopathy

Dilated Cardiomyopathy ↓ myocardial contractility→ systolic dysfunction→↓CO→↑ventricular filling pressure • Dilatation of both ventricles→ MR, TR. • Causes: the most common is IHD and alcohol • Other causes: o Direct:

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Toxic :Alcohol, Anthracyclines, Catecholamines, Cobalt, Phenothiazines, Radiation, Uremia, Adriamycin.  Infectious:Protozoan (Chagas' disease) Viral (coxsackievirus, other enteroviruses, influenza)  Metabolic :Starvation, Thiamine deficiency (beriberi)  Genetic, Idiopathic o Indirect  Ischemic • Large-vessel coronary disease (postinfarction cardiomyopathy) • Small-vessel coronary disease

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• Global ischemia (cardiac surgery)  Anemia, TTP, Hypersensitivity, Idiopathic myocarditis  Drug reactions (methyldopa, sulfonamides, foreign protein)  Abnormal loading conditions • Hypertension , Valvular heart disease, Peripartum or postpartum cardiomyopathy  Endocrine:Hyperthyroidism ,Acromegaly,Diabetes  Infiltration :Sarcoid ,Hemochromatosis , Neoplastic (lymphoma, leukemia) • Diagnosis by Echo: ↑ LVED Diameter >2.7cm/m², EF < 45% • ECG→ A fib, AV block, BBB, CXR→ Cardiomegaly. • Prognosis is poor with 75% of Pts die from CHF • Scaring in the endocardium → thrombi→ emboli systemic or pulmonary. • Management: stop alcohol, CHF treated with diuretics, digoxin, and Amrinone. o Antiarrhythmic, Anticoagulants o Immunosuppressant in case of collagen vascular disease or sarcoidosis • Management of anesthesia:

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Avoid myocardial depressant drugs Maintain normovolemia. Prevent sudden ↑ SVR Monitors: PCWP: prominent A wave→ ↓ ventricular compliance Giant V wave → MR, TR in CVP

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