Dilated cardiomyopathy differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Abdelrahman Ibrahim Abushouk, MD[2]

Overview

Dilated cardiomyopathy should be differentiated from other causes of cardiac dysfunction, in particular acute coronary syndrome, other cardiomyopathies (hypertrophic, restrictive, and ARVC/D), myocarditis, pericarditis, and cardiac toxicities.

Differentiating Dilated Cardiomyopathy from other Diseases

Dilated cardiomyopathy should be differentiated from other causes of cardiac dysfunction, in particular acute coronary syndrome, other cardiomyopathies (hypertrophic, restrictive, and ARVC/D), myocarditis, pericarditis, and cardiac toxicities.[1][2][3][4]

Disorders Etiology Clinical Presentation Laboratory Findings Electrocardiogram Echocardiography
Dilated Cardiomyopathy
  • S2 at the base
  • Ventricular and atrial dilatation
  • Increased left ventricular mass
  • Global reduction in systolic function
  • Focal wall motion abnormalities
Acute Coronary Syndrome
  • Elevated blood troponin levels (after 6 hours of attack onset)
  • Elevated blood CK-MB levels
Acute Pericarditis
  • CBC: Increased WBCs count
  • Modest increase in CK-MB
  • Elevated CRP levels.
Amphetamine/Cocaine Cardiomyopathy
  • Illicit drug use
  • Drug and toxicology screen
  • Elevated serum CK (rhabdomyolysis)
  • Impaired electrolytes levels
  • Chamber dilation
  • Regional wall motion abnormalities
  • Increased left ventricular mass
  • Increased posterior wall thickness
Arrhythmogenic right ventricular

cardiomyopathy (ARVC/D)

Diagnostic criteria are based on:
  • Localised QRS widening
  • Dilated, hypokinetic right ventricle
  • Prominent apical trabeculae
  • Dilatation of RV outflow tract
Wet Beriberi
  • Inadequate thiamine intake (rice-based foods, alcoholism, and malnutrition)
  • Increased thiamine loss (protracted vomiting)
  • Inadequate absorption (after bariatric surgery or genetic mutation)
In advanced beriberi, heart failure occurs. In advanced beriberi, heart failure occurs.
  • Reduced ejection fraction.
  • Reduced fractional shortening
  • Large cardiac chamber sizes.
  • Disturbed regional wall motion


Cardiac Tamponade
  • Acute tamponade: Cardiogenic shock, hypotension, cold extremities, peripheral cyanosis, and decreased urine output.
  • Subacute tamponade: Peripheral edema with gradual progression to the aforementioned clinical picture.
  • Increased serum CK-MB and troponin
  • Cause-related investigations as serum inflammatory markers, diagnostic pericardiocentesis, and Gallium 67 imaging.
  • Pericardial effusion.
  • Swinging of the heart within the effusion
  • Reversal of right atrial and right ventricular diastolic transmural pressures.
  • Cardiac chamber collapse
Hyperthyroidism
  • Elevated T3 and T4 hormones
  • TSH: Reduced in 1ry and Elevated in 2ry hyperthyroidism.
  • Thyroid stimulating antibodies: Elevated only in Grave's disease
The following may be present:
  • Left ventricular enhanced systolic function
  • Enhanced or impaired diastolic function
  • Heart failure with preserved ejection fraction
Hypertrophic Cardiomyopathy
  • Diastolic dysfunction
  • Septal wall thickness of >15 mm
  • Narrowing of the LV outflow tract
  • Abnormal systolic motion of the anterior leaflet of the mitral valve
Left ventricular noncompaction
  • Echocardiography
  • Steady-state free precession MRI, showing prominent trabeculations and a non-compacted to compacted (NC/C) myocardium ratio > 2.3
Myocarditis
Restrictive Cardiomyopathy Systemic diseases, such as
  • Low QRS voltages
  • Conduction abnormalities.
  • Wall and valvular thickening
  • Sparkling myocardium.

References

  1. Amosova EN (1992). "[Differential diagnosis of dilated cardiomyopathy]". Klin Med (Mosk). 70 (3–4): 14–9. PMID 1507837.
  2. Schultheiss HP, Fairweather D, Caforio ALP, Escher F, Hershberger RE, Lipshultz SE; et al. (2019). "Dilated cardiomyopathy". Nat Rev Dis Primers. 5 (1): 32. doi:10.1038/s41572-019-0084-1. PMID 31073128.
  3. Gurevich MA, Gordienko BV (2003). "[Dilated and ischemic cardiomyopathy: differential diagnosis]". Klin Med (Mosk). 81 (9): 68–71. PMID 14598597.
  4. Gurevich MA, Gordienko BV (2003). "[Dilated and ischemic cardiomyopathy: differential diagnosis]". Klin Med (Mosk). 81 (9): 68–71. PMID 14598597.


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