Heart Failure know medically as Dilated Cardiomyopathy(DCM) represents the most common form of cardiomyopathy(Heart Failure)worldwide, with a prevalence of 1 in 2,500 individuals and an incidence of 7 per 100,000 per year. DCM occurs in patients of all ages and ethnic origins, and is slightly more commonly in men than in women. Characteristic features at presentation include isolated left ventricular (LV) single chamber or biventricular dilatation(both pumping chambers) with associated impairment in systolic(pump output function), typically identified as a reduction in the measured ejection fraction (EF) on echocardiography or magnetic resonance imaging (MRI).

Pathologic examination usually reveals evidence of four-chamber cardiac enlargement, both upper chambers called the left and right Atria and both lower chambers called the left and right Ventricles with microscope evidence of myocyte (muscle cell) hypertrophy (thickening) and fibrosis(scaring).

Since DCM represents a final common pathway for progressive cardiac reshaping i.e the heart increasing in size, initiated by many different types of heart injury, the clinical course and prognosis of patients with DCM is highly variable. Important prognostic factors include the specific etiology or cause of disease, the severity of associated heart failure (HF), objectively measured functional capacity(ability to walk,run or sleep with one pillow), and the presence of complicating features such as complex  and dangerous heart arrhythmias, kidney dysfunction, and thromboembolism. The treatment of DCM is directed by evidence of what works best clinically for the patient, and focuses on pharmacologic(drugs) and device-based therapy(Pacemakers and Defibrillators) to relieve HF symptoms, prevent disease progression, and manage related risks, including stroke, sudden cardiac death, and end-organ failure.

This article series will describe the various causes,diagnostic procedures,the various treatments available and prognosis of  what is truly an epidemic problem in Cardiology today.  Don’t miss our next and future educational installments posted here each week on this and other topics of interest.

Philip R. Totonelly MD, JD FACC FSCAI

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