10.

Dilated Cardiomyopathy

1.

A: Dilated cardiomyopathy refers to global cardiac enlargement with dilation of all four heart
chambers.
c

2.

A: This dilation results in decreased myocardial contractility. This causes systolic dysfunction, leading
to progressive congestive heart failure. This condition is also known as congested cardiomyopathy.
c

3.

A: Biventricular dilated cardiomyopathy leads to an inability to move fluids throughout the body,
causing blood to pool in the heart. Appropriate systemic pressures and flow are not maintained, and
subsequent increases in pulmonary hydrostatic pressure leads to pleural effusion and edema.
c

4.

A: Dilation of cardiac tissue disrupts the electrical conduction system, leading to left and/or right
bundle branch blockages, and often presents as atrial and ventricular arrhythmias. Hypertrophy may be
characterized as eccentric hypertrophy (sarcomeres are added in series).
c

5.

A: The most commonly mutated gene in dilated cardiomyopathy is TTN, which encodes the
protein, titin.

The most common mutation in X-linked dilated cardiomyopathy is dystrophin.

c

6.

A: Other causes of dilated cardiomyopathy include (mnemonic: ABCCCCDDE):

 Alcohol abuse

 wet Beriberi
 Chagas disease
 Cocaine
  Coxsackie B virus
 peripartum Cardiomyopathy
 Doxorubicin, Daunorubicin
 hEmochromatosis
c

7.

A: Alcohol can lead to dilated cardiomyopathy through the toxic effects of acetaldehyde metabolites.
c
8.

A: Systolic dysfunction in dilated cardiomyopathy manifests with decreased cardiac output and a
reduced ejection fraction (typically around 25%). This can be detected during physical exam as
a narrow pulse pressure, a systolic regurgitant murmur, and the presence of an S3 heart sound.
c

9.

A: Ultrasound of patients with dilated cardiomyopathy shows global cardiac enlargement. Chest X-
ray shows a "balloon" appearance of the heart.
c

10.

A: 1. Takotsubo cardiomyopathy is characterized by transient left ventricular dysfunction that is

caused by catecholamine excess due to severe physical or emotional stress.

2. Echocardiography in patients with takotsubo cardiomyopathy shows characteristic left ventricular

“apical ballooning”.
c
11.

A: Medical treatment of dilated cardiomyopathy includes: BADD

 ACE inhibitors and other diuretics

 β-blockers

 Digoxin
c

12.

A : Dietary management of dilated cardiomyopathy emphasizes dietary sodium restriction.

c

13.

A: Surgical/interventional treatments for dilated cardiomyopathy include implantable cardioverter-

defibrillator (ICD) and heart transplant.