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Left Ventricular Dilatation


Presentation

  • A 58-year-old woman with a previous anterior myocardial infarction, recurrent chest pain, transient adenosine-induced left ventricular dilatation but no apparent epicardial disease on angiography is presented.[ncbi.nlm.nih.gov]
  • Presents 70 fully illustrated case presentations with teaching points that make information easy to understand and digest.[books.google.com]
Pathologist
  • Discussion Over three decades ago, the German pathologist A.J.[nejm.org]
Hypoxemia
  • In addition, most studies have only performed contrast-enhanced echocardiography in patients with hypoxemia or enlargement of the arterial-alveolar oxygen gradient, which certainly reduces the prevalence of IPV.[journals.plos.org]
Splenectomy
  • Systemic hemodynamic changes in mansonic schistosomiasis with portal hypertension treated by azygoportal disconnection and splenectomy.[journals.plos.org]
Recurrent Chest Pain
  • A 58-year-old woman with a previous anterior myocardial infarction, recurrent chest pain, transient adenosine-induced left ventricular dilatation but no apparent epicardial disease on angiography is presented.[ncbi.nlm.nih.gov]
Dyspepsia
  • The results were compared with a control group consisting of ten participants without portal hypertension who were monitored during endoscopic evaluation for dyspepsia.[journals.plos.org]
Heart Disease
  • Abstract Coronary heart disease and beta-blocker treatment can increase the use of the Frank-Starling mechanism during exercise. The aim of the study was to assess whether this could be influenced by physical training.[ncbi.nlm.nih.gov]
  • Abstract Background: Hyperhomocysteinemia is a risk factor for ischemic heart disease. Several other mechanisms apply also to dilative types of heart failure of various, non-ischemic etiologies.[degruyter.com]
  • I51.5 Myocardial degeneration I51.7 Cardiomegaly I51.8 Other ill-defined heart diseases I51.81 Takotsubo syndrome I51.89 Other ill-defined heart diseases I51.9 Heart disease, unspecified I52 Other heart disorders in diseases classified elsewhere I60[icd10data.com]
Cardiomegaly
  • 2012 ICD-9-CM Diagnosis Code 429.3 Cardiomegaly ICD-9-CM 429.3 is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim, however, 429.3 should only be used for claims with a date of service on or before September 30[icd9data.com]
  • Cardiomegaly is a nonspecific symptom seen in patients with chronic systolic heart failure (heart failure) or several forms of cardiomyopathies. Hypertrophy or enlargement of the heart.[icd10data.com]
  • Cardiomegaly on chest x-ray: prognostic implications from a ten-year cohort study of elderly subjects: a report from the Bronx Longitudinal Aging Study. Am Heart J 1992 ;124: 1026 - 1030 3. Lauer MS, Evans JC, Levy D.[nejm.org]
  • DIAGNOSTIC STUDIES ( Table 7 ) The chest x-ray may demonstrate cardiomegaly, pulmonary congestion and sometimes pleural effusion. Laboratory tests Routine tests should include CBC, electrolytes, BUN, creatinine, urinalysis.[brown.edu]
  • Cardiomegaly persisting longer than 4-6 months carries a mortality of 50% at 6 years. Subsequent pregnancies in women with cardiomyopathy carries a substantial risk of clinical deterioration, particularly in those who did not recover LV function.[emedicine.medscape.com]
Gallop Rhythm
  • rhythm, persistent jugular venous distention, systemic hypotension, peripheral vascular disease Laboratory findings Hyponatremia, persistently elevated B-type natriuretic peptide and A-type natriuretic peptide levels, elevated norepinephrine and renin[clevelandclinicmeded.com]

Workup

Microalbuminuria
  • RESULTS: Patients with concentric dilated left ventricular hypertrophy had higher albumin excretion rates (P   0.0258) and prevalence of microalbuminuria (P CONCLUSION: Left ventricular dilatation is associated with subclinical renal damage in hypertension[ncbi.nlm.nih.gov]
  • Prevalence and clinical correlates of microalbuminuria in essential hypertension: the MAGIC Study. Microalbuminuria: A Genoa Investigation on Complications . Hypertension 1997; 30 : 1135–1143. 12. Friedewald WT , Levy RI , Fredrickson DS .[nature.com]
Albuminuria
  • Albuminuria was measured as the albumin-to-creatinine ratio. Early intrarenal vascular changes, expressed as the renal volume to resistive index ratio, were evaluated by ultrasound and Doppler scan.[ncbi.nlm.nih.gov]
Left Axis Deviation
  • Left axis deviation. Poor R-wave progression with QS complexes in V1-4 (“pseudo-infarction” pattern). Frequent ventricular ectopics and ventricular bigeminy (seen with severe DCM). Ventricular dysrhythmias ( VT / VF ).[lifeinthefastlane.com]
Complete Left Bundle Branch Block
  • In a subgroup of patients with nonischemic dilated cardiomyopathy and complete left bundle branch block, late continued LV reverse remodelling may lead to normalization of LV volumes and LVEF and significant improvement in functional class.[ncbi.nlm.nih.gov]
P Mitrale
  • . - signs of pulmonary congestion. 2.ECG: - P mitral. - LV dilatation. 3.Echocardiography: - determine degree of regurge. - LV dimensions. - EF 25 Complications: LV failure. Pulmonary hypertension. AF. Thrombus formation. Rheumatic activity.[slideplayer.com]
Liver Biopsy
  • All participants underwent liver biopsy to confirm the diagnosis. Sixteen participants were males and twelve were females; the mean age was 46 years (range 30 to 70 years).[journals.plos.org]

Treatment

  • Depending on infarct size and ventricular function, continued treatment in the chronic phase of heart failure must be considered.[ncbi.nlm.nih.gov]
  • EGDS is a relatively simple technique with good results and the absence of postoperative encephalopathy, and it is the treatment of choice for the majority of groups undergoing treatment of schistosomiasis presinusoidal portal hypertension [ 5, 9, 10[journals.plos.org]
  • Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults.[nature.com]

Prognosis

  • This classification identifies subgroups differing with regard to systemic haemodynamics, left ventricular function and cardiovascular prognosis.[ncbi.nlm.nih.gov]

Etiology

  • Several other mechanisms apply also to dilative types of heart failure of various, non-ischemic etiologies. We hypothesized that hyperhomocysteinemia is associated with left ventricular (LV) dilatation and hypertrophy in dilative cardiomyopathy.[ncbi.nlm.nih.gov]
  • Regardless of etiology, cardiac enlargement is associated with decreased survival. Cardiac enlargement after acute myocardial infarction (AMI) may be a progressive process.[karger.com]
  • Etiology Although a variety of etiologies can result in a dilated cardiomyopathy which are listed as below. Some are classified as separate entities.[radiopaedia.org]
  • DILATED CARDIOMYOPATHY ETIOLOGY ( Table 3 ) Although most cases of dilated cardiomyopathy are idiopathic, several etiologies have been implicated in the pathogenesis of dilated cardiomyopathy.[brown.edu]

Epidemiology

  • الصفحة 129 - Epidemiologic aspects of infective endocarditis in an urban population. A 5-year prospective study. Medicine. ‏[books.google.com]
  • The Framingham Study: an epidemiological investigation of cardiovascular disease. Section 34.[nejm.org]
  • Epidemiological and economic burden of metabolic syndrome and its consequences in patients with hypertension in Germany, Spain and Italy; a prevalence-based model . BMC Public Health 2010; 10 : 529. 3.[nature.com]
  • […] corticosteroids; thus, timely diagnosis via EMB is prudent. [13, 14] Treatment with cyclosporine and corticosteroids is associated with a median transplant-free survival of 12.3 months compared to 3 months without immunosuppression. [15] The European Study of Epidemiology[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • These findings extend previous reports and provide a pathophysiological rationale for the observed unfavourable prognosis in patients with left ventricular dilatation.[ncbi.nlm.nih.gov]
  • PATHOPHYSIOLOGY ( Table 4A, Table 4B ) In the early stages, compensatory mechanisms (i.e. neurohormonal) help to maintain cardiac output.[brown.edu]
  • The idiopathic category should continue to diminish as more information explaining pathophysiologic mechanisms, specifically genetic-environmental interactions, becomes available. Toxins are a significant cause.[emedicine.medscape.com]
  • Pathophysiology Dilated cardiomyopathy represents the final common morphologic outcome of various biologic insults. The combination of myocyte injury and necrosis associated with myocardial fibrosis results in impaired mechanical function.[clevelandclinicmeded.com]
  • Right ventricular function in cardiovascular disease, part II: pathophysiology, clinical importance, and management of right ventricular failure. Circulation. 2008 Apr 1;117(13):1717-31.[escardio.org]

Prevention

  • This edition has new chapters on impact and treatment of comorbidities, prevention of sudden cardiac death, rationale for use of anticoagulants, ultrafiltration, use of mechanical devices, and gene and cell therapy.[books.google.com]
  • MUSTT: a randomized study of the prevention of sudden death in patients with coronary artery disease . N Engl J Med . 1999 ; 341:1882–1890.[jaha.ahajournals.org]
  • Neurohormonal blockade in patients with acute MI is shown to prevent adverse remodeling, prevent HF, and prolong survival. A reduction in wall stress during MI has been proposed to reduce infarct expansion and acute dilation.[acc.org]
  • The primary goal is to improve cardiac function and prevent symptoms. Individuals with DCM need to be followed by a cardiologist on a regular basis.[cincinnatichildrens.org]
  • In some cases, this prevents the heart from filling with blood as it should. Over time, it can affect the other chambers. Symptoms Many people with dilated cardiomyopathy have no symptoms. Some that do have only minor ones, and live a normal life.[webmd.com]

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