Dilated cardiomyopathy history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-in-Chief: Sachin Shah, M.D.

Common symptoms in the setting of dilated cardiomyopathy include chest pain, cough, fatigue, loss of appetite, and shortness of breath. A careful history is important in the setting of dilated cardiomyopathy in order to ascertain the etiology of the cardiomyopathy. The patient needs to be evaluated for a history of coronary artery disease, viral prodrome and infections, chemotherapy, HIV risk factors, pregnancy, medications, toxins, and substance abuse.

• In terms of determining the etiology, a careful history is most instrumental.^[1]
• If the patient has CAD (coronary artery disease) risk factors, known CAD, or angina then a workup for CAD should be undertaken with coronary angiography.
• A viral prodrome such as viral URI or viral gastroenteritis may make viral myocarditis as a more likely cause. If the patient was exposed to chemotherapy such as anthracyclines, then this would be the likely cause.^[2]
• Patients at risk for HIV should undergo testing as HIV can cause a dilated cardiomyopathy.
• Peripartum cardiomyopathy most often occurs 1 month prior to expected delivery or 5 months after delivery, so recent childbirth is important information. Often by 8 months gestational age pregnancy is physically apparent, but it is important to rule out pregnancy in women of childbearing age with dilated cardiomyopathy.^[3]
• Screening questions regarding cocaine or alcohol abuse or other toxin exposure (such as cobalt) should be addressed.

• Symptoms of heart failure are most common. Usually, they develop slowly over time. However, sometimes symptoms start very suddenly and are severe.

The common symptoms of dilated cardiomyopathy include:^[4]

• Chest pain or pressure (more likely when you exercise)
• Cough
• Fatigue, weakness, faintness
• Irregular or rapid pulse
• Loss of appetite
• Shortness of breath with activity or after lying down (or being asleep) for a while
• Pedal edema (in adults)

The clinical presentation of dilated cardiomyopathy is similar to that heart failure from any cause.^[5]

• Dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, lower extremity edema and orthostasis / syncope are all common findings in dilated cardiomyopathy.
• In addition, dilated cardiomyopathy may present as palpitations as a result of arrhythmia (ventricular or atrial) with the most common arrhythmia being atrial fibrillation.
• Dilated cardiomyopathy may also present as sudden cardiac death or as CVA (cerebrovascular accident) or other embolic phenomenon (either from associated atrial fibrillation or from ventricular thrombi as a result of dilated ventricular cavities).

• Angina is not a common feature of dilated cardiomyopathy unless the cause is related to coronary artery disease.

• If angina is present, work up for cardiac ischemia should be undertaken.^[4]

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