Symptoma

Cardiomyopathy

Diseases Myocardial

Cardiomyopathy refers to a clinical disease that involves the muscles of the heart. Cardiomyopathy usually causes the heart muscles to grow thicker, and more rigid than the normal myocardium. The progressive scarring of the heart muscle may sometimes replace the physiologic role of the normal myocardium.

Patients diagnosed with Restrictive Cardiomyopathy will present with the following signs and symptoms:

Patients diagnosed with Dilated Cardiomyopathy will present with the following signs and symptoms:

Majority of patients with Hypertrophic Cardiomyopathy (HCM) are asymptomatic. The following symptomatology may be seen in patients with HCM:

  • Fatigue

    These signs and symptoms include: Shortness of breath or trouble breathing, especially with physical exertion Fatigue (tiredness) Swelling in the ankles, feet, legs, abdomen, and veins in the neck Other signs and symptoms may include dizziness; light-headedness [web.archive.org]

    Symptoms: Patients with cardiomyopathy will typically present with dyspnea, orthopnea, paroxysmal nocturnal dyspnea, bilateral edema, and fatigue. [symptoma.com]

    Common symptoms of heart failure include shortness of breath, fatigue and swelling of the ankles, feet, legs, abdomen and veins in the neck. [heart.org]

    It can also result from the use of alcohol, illicit drugs or certain medications. sümptomid Symptoms may include shortness of breath, fatigue and a rapid heart rate. [capitalcardiology.com]

  • Congestive Heart Failure

    Unfortunately, some women never recover and go on to develop chronic congestive heart failure with a death rate of 85% within five years. [womensheart.org]

    The three common cardiomyopathies are: Dilated cardiomyopathy: This results in left ventricular systolic dysfunction and clinical manifestations of congestive heart failure. [healio.com]

    The end result of this is congestive heart failure—the heart cannot pump enough blood for the body's organs to function properly. The December 15, 2004, issue of JAMA includes an article about cardiomyopathy. [jamanetwork.com]

    The progressive stretch of the heart’s myocardium reduces the volume of the cardiac output contributing to the development of congestive heart failure. [symptoma.com]

    The goal of treatment is to control or prevent congestive heart failure, improve heart function and prevent complications, such as arrhythmias and blood clots. [ucsfbenioffchildrens.org]

  • Pallor

    Affected individuals may also experience excessive sweating, fatigue, wheezing, and paleness of the skin (pallor). [rarediseases.org]

  • Anorexia

    Edema caused by malnutrition defines kwashiorkor, an acute form of childhood protein-energy malnutrition characterized by edema, irritability, anorexia, ulcerating dermatoses, and an enlarged liver with fatty infiltrates. [en.wikipedia.org]

  • Ankle Edema

    Leg swelling (ankle edema). Liver enlargement. Chest pain. Risk Factors Age over 60. Obesity. Smoking. Alcoholism. Family history of coronary artery disease or cardiomyopathy. [rxmed.com]

  • Dyspnea

    Symptoms: Patients with cardiomyopathy will typically present with dyspnea, orthopnea, paroxysmal nocturnal dyspnea, bilateral edema, and fatigue. [symptoma.com]

    However, after 10 infusions the patient developed dyspnea, edema of the legs, ascites and a weight gain of 10 kg because of a decompensated heart insufficiency with a reduced ejection fraction from formerly 48%-50% to 15%. [ncbi.nlm.nih.gov]

    Symptoms of heart failure may include shortness of breath, fatigue, cough, orthopnea, paroxysmal nocturnal dyspnea, and edema. This presentation is common in patients with dilated cardiomyopathy. [aafp.org]

  • Exertional Dyspnea

    dyspnea Angina pectoris Dizziness, lightheadedness, syncope Palpitations, cardiac arrhythmias Sudden cardiac death (particularly during or after intense physical activity) Physical examination Systolic ejection murmur (crescendo-decrescendo) Increases [amboss.com]

    dyspnea, angina, syncope, sudden death Systolic murmur mitral regurgitation murmur, S4 Bifid carotid pulse with a brisk upstroke and rapid downstroke Exertional dyspnea and fatigue LV RV failure Functional AV valve regurgitation ECG Nonspecific ST- and [merckmanuals.com]

    dyspnea. 2,3 Thus, a high index of suspicion is necessary for diagnosis. [scielo.mec.pt]

    dyspnea, fatigue, weakness, and tachycardia.[15] It may lead to heart failure.[15] Anaemia is often a cause of dyspnea. [en.wikipedia.org]

  • Pleural Effusion

    Associated pleural effusions may also be seen. [radiopaedia.org]

    Some patients will also have pleural effusions detected by decreased breath sounds at the bases and dullness to percussion. Women with cardiomyopathy not due to a viral cause will be afebrile. [clinicaladvisor.com]

    For example, severe heart failure can cause pulmonary edema, pleural effusions, ascites and peripheral edema. Such severe systemic edema is called anasarca. [en.wikipedia.org]

    Pulmonary multi-detector computed tomography angiography excluded acute pulmonary embolism but revealed bilateral pulmonary infiltration and pleural effusion suggesting acute pulmonary edema. transthoracic echo-cardiography (TTE) revealed four-chamber [scielo.mec.pt]

    Common abnormalities seen on the chest radiograph include cardiomegaly, interstitial edema, pleural effusion(s), and evidence of previous sternotomy (sternal wires). [clevelandclinicmeded.com]

  • Rales

    The recent RALES study11 has shown that the addition of 25 mg of spironolactone to conventional treatment in patients with an ejection fraction  35% and a history of NYHA class IV heart failure is associated with a 30% reduction in the overall risk of [heart.bmj.com]

    Clinical features Exertional dyspnea Angina pectoris Palpitations Diffuse abdominal and peripheral edema Jugular venous distention Left ventricular impulse displacement Relative mitral valve regurgitation or tricuspid valve regurgitation S3 gallop Rales [amboss.com]

    Pulmonary auscultation showed bilateral rales and wheezing. Arterial gasometry revealed chronic respiratory alkalosis and oxygen saturation of 95%. [scielo.mec.pt]

    Classical symptoms of congestive heart failure and physical findings of tachycardia, tachypnea, rales in the lung bases and jugular venous distention make a diagnosis of cardiomyopathy or other heart disease likely. [clinicaladvisor.com]

  • Tachypnea

    Classical symptoms of congestive heart failure and physical findings of tachycardia, tachypnea, rales in the lung bases and jugular venous distention make a diagnosis of cardiomyopathy or other heart disease likely. [clinicaladvisor.com]

    […] transcribe them (less-used variants are omitted): Group Term Combining forms Preponderance of transcriptions (major dictionaries) good eupnea eu- -pnea yoop-NEE-ə[34][35][33][36] bad dyspnea dys- -pnea disp-NEE-ə,[35][36][37] DISP-nee-ə[34][33] fast tachypnea [en.wikipedia.org]

    […] predominance being described in some reviews, 9,12 and in the pediatric population it is most common in the first year of life 38–40 with about 20% presenting in the neonatal period. 40 Infants with D CM often present with symptoms of HF 13,39–42 such as tachypnea [revportcardiol.org]

  • Hepatomegaly

    Missense; Gln303Lys LCAD protein Location: Mitochondrial matirx Action: Catalyzes 1st step in mitochondrial β-oxidation of fatty acids Onset: Early childhood Episodes: Associated with fasting Hypoglycemia, Hypoketotic Cardiac arrest Clinical findings Hepatomegaly [neuromuscular.wustl.edu]

    […] compliance diastolic filling atrial congestion atrial enlargement and severe diastolic dysfunction systemic venous congestion Clinical features Most common: dyspnea Symptoms of right heart failure Jugular venous distention Peripheral edema, ascites Hepatomegaly [amboss.com]

    Additional symptoms may include fluid collection in the abdomen (ascites) and feet due to accumulation of fluid, congestion of the lungs, and an abnormally large liver (hepatomegaly). [rarediseases.org]

    13,40,42 Physical examination can reveal a displaced apical impulse, 13,41 muffled heart sounds 41 with a third heart sound, 13,41 a mitral regurgitation murmur 13,41 or signs of pulmonary congestion. 13 Signs of systemic venous congestion including hepatomegaly [revportcardiol.org]

  • Hepatosplenomegaly

    The acute presentation is characterized by dyspnea, fever, myalgia, hepatosplenomegaly, and myocarditis. Chronic infection involves the esophagus, colon, and heart. [emedicine.medscape.com]

  • Heart Failure

    Heart failure: management and prognosis. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 59. O'Connor CM, Rogers JG. Heart failure: pathophysiology and diagnosis. [medlineplus.gov]

    When heart failure become progressively worse, cardiac transplant may be the only option for RCM. [symptoma.com]

    Anna Adam Heart failure specialist nurse, Lancashire Teaching Hospitals NHS Trust, Chorley Christopher Nicholson Cardiac nurse specialist–heart failure, Central Lancashire Primary Care Trust, Preston Lynn Owens Nurse consultant–alcohol services, University [doi.org]

    Left bundle branch block increases the risk of death in patients with chronic heart failure. [ncbi.nlm.nih.gov]

  • Heart Disease

    Understand Your Risk for Cardiomyopathy Symptoms and Diagnosis of Cardiomyopathy Prevention and Treatment of Cardiomyopathy Cardiomyopathy in Children Learn more: Family History and Heart Disease Alcohol and Heart Disease Cocaine, Marijuana and Other [heart.org]

    From Wikidata Jump to navigation Jump to search A heart disease and a myopathy that is characterised by deterioration of the function of the heart muscle edit English cardiomyopathy A heart disease and a myopathy that is characterised by deterioration [wikidata.org]

    This study aims to help train staff on a range of heart conditions by evaluating patients of all ages at the National Institutes of Health Clinical Center who have heart disease or are at risk of heart disease. [nhlbi.nih.gov]

  • Chest Pain

    We report the case of a 76-year-old man with a dual chamber pacemaker, admitted for acute chest pain and dyspnea and final diagnosis of TC. One month after index admission, the patient came back complaining again of chest pain. [ncbi.nlm.nih.gov]

    You develop chest pain, palpitations, faintness, or other new or unexplained symptoms. [medlineplus.gov]

    pain, especially after physical exertion or heavy meals; and heart murmurs. [web.archive.org]

  • Palpitations

    Symptoms include palpitations and fainting after physical activity. Palpitations are feelings that your heart is skipping a beat, fluttering or beating too hard or too fast. ARVD usually affects teens or young adults. [heart.org]

    At a clinic visit 5 months later, she had received no ICD shocks and reported no symptoms of severe palpitations. [nejm.org]

    Palpitation Palpitation is an uncomfortable awareness of the heart beat. People may occasionally feel an extra beat or a skipped beat and this is usually normal. Sometimes an awareness of the heart beating does suggest and irregular heart rhythm. [ineaia.tripod.com]

    You develop chest pain, palpitations, faintness, or other new or unexplained symptoms. [medlineplus.gov]

    Patients diagnosed with Restrictive Cardiomyopathy will present with the following signs and symptoms: Shortness of breath Exercise intolerance Chronic fatigue Paroxysmal Nocturnal Dyspnea (PND) Abdominal distention Bilateral peripheral edema Palpitation [symptoma.com]

  • Tachycardia

    Junctional ectopic tachycardia (JET) is a rare form of arrhythmia that is most commonly seen during infancy. [ncbi.nlm.nih.gov]

    Palpitations (fluttering in the chest) due to abnormal heart rhythms (arrhythmias) such as atrial fibrillation or ventricular tachycardia. [my.clevelandclinic.org]

    A 68-year-old woman presented with symptoms of palpitations and was found to have frequent premature ventricular contractions and nonsustained ventricular tachycardia. [nejm.org]

The following laboratory work up and tests are done to investigate patients with impending cardiomyopathy:

  • Chest X-ray – Chest radiographs will show whether the heart is enlarged.
  • Echocardiography – This makes use of sound waves that determines size and functions of the heart. 
  • Electrocardiogram (ECG) – This diagnostic modality uses chest electrodes to determine the electrical activity of the heart. This can detect abnormal rhythms and enlargement by voltage.
  • Magnetic Resonance Imaging (MRI) – This makes use of magnetic fields and radio waves to determine a more detailed image of the heart [8].
  • Cardiac Catheterization – This procedure makes use of a slender flexible tube inserted in the major vessels to the heart where a sample biopsy of the heart tissue may be taken for laboratory examination.
  • Laboratory tests – blood test like the Beta-type natriuretic peptide (BNP) are tested for elevation due to heart failure which is seen as a common complication of cardiomyopathy. Troponin I may also be used to prognosticate heart failures in cardiomyopathy [9].
  • Pericardial Effusion

    In both patients, echocardiography showed LV hypertrophy, biventricular systolic dysfunction, and a large amount of pericardial effusion. [ncbi.nlm.nih.gov]

    On plain radiographs consider: large pericardial effusion Promoted articles (advertising) [radiopaedia.org]

    Heart - pericardial effusion [# 4, median year 2008 (2000-2014)] The heart itself can be greatly affected in CD patients. Echocardiography has been used to show that there is a higher incidence of pericardial effusion in CD[ 93 ]. [doi.org]

    pericardial effusion, granular myocardial appearance, atrial enlargement, and thickened papillary muscles and valves, with valvular dysfunction if endocardial involvement is present. [44] Two-dimensional speckle tracking demonstrates “apical sparing” [emedicine.medscape.com]

  • ST Elevation

    elevation (or, less commonly, ST depression), QT interval prolongation, T wave inversion, abnormal Q waves Laboratory: slightly troponin T;, BNP Echocardiography: apical left ventricular ballooning, LVEF Coronary angiography: usually no pathological [amboss.com]

    Diagnostic criteria ECG/Holter/stress test features Newly abnormal 12 lead ECG and/or Holter and/or stress testing, any of the following: I to III degree atrioventricular block, or bundle branch block, ST/T wave change (ST or non-ST elevation, T-wave [intechopen.com]

    Heart - infarction [# 5, median year 2009 (2008-2015)] Acute myocardial infarction with ST-elevation and spontaneous coronary artery dissection can occur in young patients with CD[ 3, 136 ]. [doi.org]

  • Right Bundle Branch Block

    TAD terminal activation duration, IRBBB incomplete right bundle branch block, CRBBB complete right bundle branch block. Undiagnosed cases with family history positive for ARVC have a higher risk of developing arrhythmias. [hrcak.srce.hr]

    ECG repolarization abnormalities Minor Inverted T waves in right precordial leads (V 2 and V 3 ) in people 12 years of age and in absence of right bundle branch block. 4. [ncbi.nlm.nih.gov]

    First described in 1992, the syndrome is identified by a distinctive ECG pattern consisting of right bundle-branch block and coved ST-segment elevation in the anterior precordial leads (V 1 through V 3 ). [web.archive.org]

  • Incomplete Right Bundle Branch Block

    The second characteristic is the appearance of a complete or incomplete right bundle branch block (RBBB) that indicates disordered conductivity of the Purkinje fibers. [hrcak.srce.hr]

  • Ventricular Bigeminy

    Frequent ventricular ectopics and ventricular bigeminy (seen with severe DCM). Ventricular dysrhythmias ( VT / VF ). ECG Examples Example 1 Ischaemic dilated cardiomyopathy: There is marked LVH (S wave in V2 35 mm) with dominant S waves in V1-4. [lifeinthefastlane.com]

  • T Wave Inversion

    Young age, family history of juvenile sudden death, QRS dispersion 40 ms, T-wave inversion, left ventricular involvement, ventricular tachycardia, syncope and previous cardiac arrest are the major risk factors for adverse prognosis. [ncbi.nlm.nih.gov]

    wave inversion, abnormal Q waves Laboratory: slightly troponin T;, BNP Echocardiography: apical left ventricular ballooning, LVEF Coronary angiography: usually no pathological findings (e.g., no obstruction of coronaries by plaque rupture); a minority [amboss.com]

    New electrocardiographic abnormalities either ST-segment elevation and/or T-wave inversion or modest elevation in cardiac troponin level. Absence of pheochromocytoma or myocarditis. [radiologyassistant.nl]

  • Myocardial Fibrosis

    KEYWORDS: diabetic cardiomyopathy; heart failure; inflammation; metabolic dysregulation; myocardial fibrosis [ncbi.nlm.nih.gov]

    Myocardial fibrosis correlated with systolic function, and patients with poor outcomes had more extensive myocardial fibrosis. [jamanetwork.com]

    Because localizing focal fibrosis with LGE involves "nulling" the signal of surrounding myocardium, the technique is unable to identify more diffuse interstitial myocardial fibrosis. [emedicine.com]

    fibrosis Role in prognosis Differential diagnosis Nuclear imaging Endomyocardial biopsy Laboratory tests Genetic testing and family screening Counselling in probands Methods for molecular genetic screening in probands Indications for genetic testing [escardio.org]

    Diffuse myocardial fibrosis may lead to reduced voltage QRS complexes, particularly in the limb leads. There may be a discrepancy of QRS voltages with signs of hypertrophy in V4-6 and relatively low voltages in the limb leads. [lifeinthefastlane.com]

  • Biventricular Hypertrophy

    The most common ECG abnormalities are those associated with atrial and ventricular hypertrophy — typically, left sided changes are seen but there may be signs of biatrial or biventricular hypertrophy. Interventricular conduction delays (eg. [lifeinthefastlane.com]

  • Pleural Effusion

    Associated pleural effusions may also be seen. [radiopaedia.org]

    Some patients will also have pleural effusions detected by decreased breath sounds at the bases and dullness to percussion. Women with cardiomyopathy not due to a viral cause will be afebrile. [clinicaladvisor.com]

    For example, severe heart failure can cause pulmonary edema, pleural effusions, ascites and peripheral edema. Such severe systemic edema is called anasarca. [en.wikipedia.org]

    Pulmonary multi-detector computed tomography angiography excluded acute pulmonary embolism but revealed bilateral pulmonary infiltration and pleural effusion suggesting acute pulmonary edema. transthoracic echo-cardiography (TTE) revealed four-chamber [scielo.mec.pt]

    Common abnormalities seen on the chest radiograph include cardiomegaly, interstitial edema, pleural effusion(s), and evidence of previous sternotomy (sternal wires). [clevelandclinicmeded.com]

For restrictive cardiomyopathy, therapeutic modalities are focused on the alleviation of the symptoms. Water and salt intake monitoring is paramount to prevent overload. In some case, patients are given diuretics to unload water retention in RCM. When heart failure become progressively worse, cardiac transplant may be the only option for RCM.

Dilated cardiomyopathy are medically treated with Angiotensin converting enzyme inhibitors, Angiotensin receptor blockers, beta blockers, digoxin, and diuretics [10]. A pacemaker may be installed in patients with DCM to synchronize any irregular cardiac rhythm. Hypertrophic cardiomyopathy are given medications to relax the heart muscles like beta blockers and calcium channel blockers. Cardiac surgeries like septal myectomy and septal ablation are some of the surgical options elected to debulk the thickened muscles of the heart.

In both children and adult population the outlook for restrictive cardiomyopathy is generally poor. Most patient progress to low output heart failure which may complicate to thromboembolism or cardiac cirrhosis. There is a higher mortality rate in dilated cardiomyopathy associated with severe congestive heart failure (CHF), male sex, and increasing age. About half of the patients with DCM presenting with CHF will die within the first 5 years from diagnosis [5]. Although patients with DCM having mild CHF carries a brighter outlook. Hypertrophic cardiomyopathy carries the best prognosis with only 1-3% mortality rating [6]. Majority of the mortality seen in HCM is due to sudden death caused by ventricular tachycardia and fibrillation. Morbidity and mortality improves with early diagnosis and intervention of the HCM disease [7].

In the majority of cases of cardiomyopathy, the etiologic causation is often times unknown. The following pre-morbid causes has been implicated as the most common identifiable causes of cardiomyopathy in clinical practice:

In the world wide scale, the reported incidence of cardiomyopathy is up to 400,000 to 550,000 diagnosed cases per annum prevailing in up to 5 million people. In the United States, the most common form of restrictive myocarditis is the idiopathic type. The prevalence of endomyocardial fibrosis (EMF) abounds in the subtropical areas of Africa among children and young adults [1]. Causing 25% of the deaths due to heart diseases in the same African regions.

Dilated cardiomyopathy can affect patients at any age but symptoms usually surface in the third and fourth decade of life. Hypertrophic cardiomyopathy (HCM) represents 0.5% of patient brought in for diagnostic echocardiography [2]. The worldwide prevalence rate of HCM is only 50 to 200 cases per 100,000 population [3]. HCM has a slight male predilection over the female population with a peak mean age of occurrence at the third decade of life. Although in the adult population, the majority of the diagnosed cases HCM are within the 30’s to 60’s age range.

In restrictive cardiomyopathy (RCM), the stiffness in the myocardium can give rise to an increased intra ventricular pressure even in the light of a smaller stroke volume [4]. The restrictive effect on the ventricular volume can lead to diastolic heart failure because of the progressive loss of stroke volume due to the muscular restriction. Fibrotic changes in the heart muscles can cause cardiac scarring on the heart surface and cause bundle branch block in the electrophysiology of the heart.

In the dilated cardiomyopathy cases, the ventricle begins to enlarge due to the chronic left ventricular failure causing both systolic and diastolic type of heart failures. The progressive stretch of the heart’s myocardium reduces the volume of the cardiac output contributing to the development of congestive heart failure. The progressive dilatation of the ventricles can lead to the development of an acquired tricuspid and mitral valve regurgitation defects.

The progressive hypertrophy of the heart muscles in hypertrophic cardiomyopathy increases the pressure gradient in the outflow tracts of the circulating blood. Mitral valve dysfunction happens in hypertrophic cardiomyopathy when the hypertrophy involves the heart papillary muscles and the muscular septal hypertrophy displacing the outflow tract of the mitral valve. The thickening of the heart muscles can also impair the calcium channel physiology.

In most cases, cardiomyopathy could not be prevented. Patients can only modify some activities that may result in heart failure with cardiomyopathy like abstaining from alcohol or recreational drugs. A balanced diet with adequate vitamins and minerals can actively prevent heart failure in some cases of cardiomyopathies.

Cardiomyopathy is a general term given to abnormal heart muscles. Clinically, there are basically three types of cardiomyopathies: Restrictive, Dilated, and Hypertrophic cardiomyopathy. This abnormalities seen in the heart muscles retards the normal delivery of blood throughout the organ systems of the body. Cardiomyopathy can progress to serious heart failure if left untreated. Treatment approaches to cardiomyopathy grossly depends on the type and could be therapeutically corrected by either surgical or medical means.

  • Definition: Cardiomyopathy refers to any clinical disease that involves the muscles of the heart that results in the alteration in the shape and size of the myocardium.
  • Cause: A number of pre-morbid causes can give rise to cardiomyopathy like hypertension, thyroid diseases, diabetes, cardiac scarring, and viral infections.
  • Symptoms: Patients with cardiomyopathy will typically present with dyspnea, orthopnea, paroxysmal nocturnal dyspnea, bilateral edema, and fatigue.
  • Diagnosis: Cardiomyopathy work up includes: Chest X-ray, ECG, MRI, Echocardiography, blood tests, and cardiac catheterizations.
  • Treatment and follow-up: Medical treatment of cardiomyopathy includes the usage of beta blocker, digoxin, ACE inhibitors, and calcium channel blockers. Surgical cardiac muscle myectomy and ablation may also be used to debulk the heart. 
  1. Braunwald E, Abelmann WH. Atlas of Heart Diseases. Vol 2. 1994:53-61.
  2. Maron BJ, Peterson EE, Maron MS, Peterson JE. Prevalence of hypertrophic cardiomyopathy in an outpatient population referred for echocardiographic study. Am J Cardiol. Mar 15 1994; 73(8):577-80.
  3. Maron BJ, Gardin JM, Flack JM, et al. Prevalence of hypertrophic cardiomyopathy in a general population of young adults. Echocardiographic analysis of 4111 subjects in the CARDIA Study. Coronary Artery Risk Development in (Young) Adults. Circulation. Aug 15 1995; 92(4):785-9.
  4. Goldstein JA. Differentiation of constrictive pericarditis and restrictive cardiomyopathy. ACC Ed Highlights. Fall 1998; 14-22.
  5. McKee PA, Castelli WP, McNamara PM, Kannel WB. The natural history of congestive heart failure: the Framingham study. N Engl J Med. Dec 23 1971; 285(26):1441-6.
  6. Maron BJ. Hypertrophic cardiomyopathy: a systematic review. JAMA. Mar 13 2002; 287(10):1308-20.
  7. DeRose JJ Jr, Banas JS Jr, Winters SL. Current perspectives on sudden cardiac death in hypertrophic cardiomyopathy. Prog Cardiovasc Dis. May-Jun 1994; 36(6):475-84.
  8. Francone M. Role of cardiac magnetic resonance in the evaluation of dilated cardiomyopathy: diagnostic contribution and prognostic significance. ISRN Radiol. 2014; 2014:365404.
  9. La Vecchia L, Mezzena G, Zanolla L, Paccanaro M, Varotto L, Bonanno C, et al. Cardiac troponin I as diagnostic and prognostic marker in severe heart failure. J Heart Lung Transplant. Jul 2000; 19(7):644-52.
  10. Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR, et al. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med. Mar 3 2011; 364(9):797-805.

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