Hospital therapy. Clinical picture and diagnosis of dilated cardiomyopathy (DCM) (most important)

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Hospital therapy. Clinical picture and diagnosis of dilated cardiomyopathy (DCM) (most important)

Lecture notes, cheat sheets

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8. Clinical picture and diagnosis of dilated cardiomyopathy (DCM)

There are no specific signs of the disease. The clinical picture is polymorphic and is determined by:

1) symptoms of heart failure;

2) rhythm and conduction disturbances;

3) thromboembolic syndrome.

In most cases, the prognosis of the disease is determined by the defeat of the left ventricle of the heart. Before the onset of heart failure, DCM is latent. The most frequent complaints of already onset heart failure are complaints of decreased performance, increased fatigue, shortness of breath during exertion, and then at rest. At night, he has a dry cough (the equivalent of cardiac asthma), later - typical asthma attacks. Patients present with characteristic anginal pain. With the development of congestion in the systemic circulation, heaviness appears in the right hypochondrium (due to an enlarged liver), swelling of the legs.

Diagnostics. When diagnosing the disease, an important sign is a significant increase in the heart (there are no signs of valvular heart disease or arterial hypertension). Cardiomegaly is manifested by the expansion of the heart in both directions, determined by percussion, as well as the displacement of the apex beat to the left and down. In severe cases, a gallop rhythm, tachycardia, murmurs of relative insufficiency of the mitral or tricuspid valves are heard. In 20% of cases, atrial fibrillation develops. Blood pressure is usually normal or slightly elevated (due to heart failure).

Biochemical studies of blood and urine can detect various toxic substances, as well as vitamin deficiencies. Instrumental research methods make it possible to detect:

1) signs of cardiomegaly;

2) changes in indicators of central hemodynamics;

3) rhythm and conduction disturbances. Phonocardiogram confirms auscultatory data in the form of a gallop rhythm, a fairly common detection of systolic murmur.

X-ray reveals a significant increase in the ventricles and stagnation of blood in the pulmonary (small) circulation.

Echocardiography helps to detect dilatation of both ventricles, hypokinesia of the posterior wall of the left ventricle, paradoxical movement of the interventricular septum during systole.

A radioisotope study of the heart (myocardial scintigraphy) is performed to clarify the state of the pumping function of the heart, as well as to determine the zones of the dead myocardium.

Angiocardiographically, the same changes are detected as on the echocardiogram. Live myocardial biopsy is not informative for determining the etiology of cardiomyopathy. In some cases, a viral antigen or an increase in the content of LDH, as well as a decrease in energy production by mitochondria, can be detected in the biopsy.

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