Cardiology Question 38 Instructor

What is the definition and the causes of dilated cardiomyopathy?

Primary myocardial failure in the absence of underlying coronary, valvular, or pericardial disease.

Causes include:

  1. Toxins
    • Ethanol
    • Chemotherapy agents e.g. anthracyclines(adriamycin), cyclophosphamide
    • Heavy metals (cobalt, lead, mercury)
    • Cocaine, Catecholamines
    • Antiretroviral agents
    • Radiation
    • Psychothreapeautic drugs (tricyclic, quadricyclic, phenothiazine)
  2. Metabolic abnormalities
    • Nutritional deficiencies (thiamine, selenium, carnitine, kwashiorkor)
    • Endocrine (hyper/hypothyroidism, acromegaly, Cushing’s, pheochromocytoma, diabetes)
    • Electrolyte abnormalities (Uremia, Hypokalemia, hypomagnesemia, Hypocalcemia/phosphatemia)
  3. Infectious
    • Viral (Coxsackie B, CMV, HIV)
    • Rickettsia
    • Diphtheria
    • Mycobacteria
    • Fungal
    • Parasitic(toxoplasmosis, trichinosis, Chagas’)
  4. Inflammatory
    • Collagen vascular(scleroderma, lupus, dermatomyositis)
    • Hypersensitivity
    • Sarcoidosis
    • Granulomatous disease e.g. Wegener’s granulomatosis
    • Giant cell arteritis
    • Peripartum (1 month before and 5 months after)
  5. Neuromuscular syndromes
    • Duchenne’s
    • Facioscapulohumeral muscular dystrophy
    • Erb’s limb-girdle dystrophy
    • Myotonic dystrophy
    • Friedrich’s ataxia
  6. Familial cardiomyopathies
  7. Neoplasms
  8. CAD with diffuse epicardial coronary-artery disease (if CAD is not excluded as an etiology)

In North America, the most common causes are:

  1. CAD
  2. Post-viral myocarditis
  3. Alcoholic cardiomyopathy

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