Study of Clinical Profile of Dilated Cardiomyopathy
BACKGROUND: Cardiomyopathy is a disease of the heart muscle that makes it harder for the heart to pump blood to the rest of the body. Cardiomyopathy can lead to heart failure. The main types of cardiomyopathies include dilated, hypertrophic and restrictive cardiomyopathy. Treatment — which might include medications, surgically implanted devices, heart surgery or, in severe cases, a heart transplant — depends on the type of cardiomyopathy and how serious it is[1]. Dilated Cardiomyopathy (DCM) is a disease of the heart muscle characterized by enlargement and dilation of one or both of the ventricles along with impaired contractility defined as left ventricular ejection fraction (LVEF) less than 40%. Patients have systolic dysfunction and may or may not have overt symptoms of heart failure. A previous prominent classification of cardiomyopathies (1995) was represented in a very brief document under the auspices of the World Health Organization (WHO)[2], The natural history of DCM remains incompletely understood. This is because this diagnosis clearly contains a variety of causes and patients have highly variable presentations. The prognosis of DCM may be much more variable than previously appreciated. Several features of the clinical presentation may be valuable in predicting patient outcome. In view of high prevalence of heart failure and also lack of data on dilated cardiomyopathy this study was undertaken. The ECG and echocardiography were also evaluated in the present study. METHODS - A cross sectional study on 60 patients with dilated cardiomyopathy was conducted in a teaching hospital in Vadodara, Gujarat. RESULTS - In our study the most common type of dilated cardiomyopathy was idiopathic dilated cardiomyopathy being present in 60% of our patients, followed by alcoholic cardiomyopathy seen in 15 %. Diabetic cardiomyopathy was found to be the third most common type seen in 13.3% of patients while Peripartum cardiomyopathy were seen in 11.6%. n our study 32 % of patients had anemia, most of the patients had mild anemia (i.e., Hb between 8.5 – 11 gm %). In a study done by A. Justin et al anemia was found in 27% of patients with congestive heart failure. The prevalence of anemia in our study is similar. Anemia is known to be associated with adverse outcome in patients with heart failure. Among alcoholic's alcohol plays a significant etiological role (p value <0.0001). Biventricular failure was present in 70% of patients and isolated LV failure was seen in 27%, 3% patient in our study had RV failure. The cardio thoracic ratio was more than 0.7 in 22%, it was between 0.6 to 0.7(moderate) in 43% and 35% of patients had mild cardiomegaly i.e., between 0.5 to 0.6 CONCLUSION- The major cause of dilated cardiomyopathy in our study was found to be idiopathic followed by alcoholic, diabetic and peripartum cardiomyopathy. The most common clinical presentation is biventricular failure. Almost all patients showed cardiomegaly in chest x-ray.