cardiovascular disorders
Dilated Cardiomyopathy
Diagnosis of Dilated Cardiomyopathy
Chest x-ray ECG Echocardiography Cardiac MRI Endomyocardial biopsy (selected cases) Testing for cause as indicated Diagnosis of dilated cardiomyopathy is by history, physical examination, and exclusion of other common causes of ventricular failure (eg, systemic Hypertension , primary are measured if acute symptoms or chest pain is present. Although typically indicative of coronary ischemia, troponin elevation often occurs in Heart Failure (HF) , especially if renal function is decreased. Serum natriuretic peptide levels are typically elevated when heart failure is present. Specific causes suspected clinically are diagnosed (see elsewhere in THE MANUAL). If no specific cause is clinically apparent, serum ferritin and iron-binding capacity and thyroid-stimulating hormone levels are measured. Serologic testsforToxoplasma,T. cruzi, coxsackievirus, HIV, and echovirus may be done in appropriate cases. Chest x-rayshows cardiomegaly, usually of all chambers. Pleural effusion, particularly on the right, often accompanies increased pulmonary venous pressure and interstitial edema. Electrocardiography None Echocardiography None Magnetic Resonance Imaging (MRI) in Cardiac Diagnosis None Positron Emission Tomography (PET) in Cardiac Diagnosis None Coronary angiographymay be required to exclude coronary artery disease as the cause of LV dysfunction when the diagnosis is in doubt after noninvasive tests. Patients with chest pain or several cardiovascular risk factors and older patients are more likely to have coronary artery disease. Biopsy of either ventricle can be done during catheterization in select cases where the results will change management. Endomyocardial biopsyis indicated if giant cell myocarditis, eosinophilic myocarditis, or sarcoidosis is suspected, as the results will affect management. 