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1、DilatedCardiomyopathyDCMGUJunDept.of CardiovascularMedicineCaseA36yearoldmancomestoyourofficecomplainingofthreemonthsofprogressivefatigueanddyspneaonexertion.Severaltimesinthepastmonthhehasawakenedfromsleepwithseverebreathlessnessandfeltaneedtositupinordertobrea
2、th.Hedeniesanychestpain.Hehasnopastmedicalhistoryofheartdisease,hypertensionordiabetes.Hisfamilyhistoryisnegativeforheartdisease.Hedoesnotsmokeanddrinksalcoholonlyrarely.Hetakesnomedications.PhysicalExaminationBP105/70mmHg,P98regularLungs:rales.Heart:Enlargedhear
3、tborder.S1diminishedintensity,S2normal,S3ispresent.2/6systolicmurmurattheapex.Abdomen:Liverisenlargedandslightlytendertopressure.Extremities:Mildedemaofbothfeet.DilatedCardiomyopathy,DCMDefinitionHeartmuscledisorderEnlargedleftventricleorbothventriclesImpairedsys
4、tolic pumpfunctionOftenwithmanifestationofheartfailureorarrhythmiaEpidemiologyAnnualincidence:5-10patientspermillionMale-femaleratio:2.5:1Averageageofincidence:40HigherincidenceinthedevelopingcountriesAnnualmortalityrate:25%-45%EtiologyNotclearFamilial/genetic(20
5、%)ViralinfectiousagentsandautoimmuneAcuteviral myocarditiscanprogresstochronicdilatedcardiomyopathyChronichormonaldisordersUseofcertainsubstances,especiallyalcohol,cocaine,antidepressants,andchemotherapydrugsPathologyGrossexamination:ThinnedventricularwallsEnlarg
6、edventriclesFibrinandscarMuralthrombusNormalvalvesandcoronaryarteriesDCMNormalMicroscopicexamination:Myocardialcellmaybehypertrophy,denaturation,fibrosisornecrosis.PathologyPathophysiologyPumplessbloodforthebody'sneedsHeartfailureMyocardialchangesinvolveconductio
7、nsystemArrhythmiaMuralthrombusfalloffEmbolismClinicalManifestationSymptoms:NosymptomintheearlystageFatigue,dyspnea,orthopneaAnorexia,edemaPalpitation,arrhythmia(Af,VT)Embolism(brain,lung,lowerextremity)Suddendeath(VT,embolism,bradycardia)ClinicalManifestationSign
8、s:CardiacdullnessextendstoleftanddownwardsRales,pleuraleffusionJugularvenousdistention,hepatomegaly,edemaGalloprhythm,S3,S4Systolicmurmurovertheapexarea(mitral