N C Joshi
Dilated Cardiomyopathy - Investigations
The cardiomyopathies constitute a group of acute or chronic myocardial diseases. They share certain general characteristics:
- X ray: Demonstrates cardiomegaly often with pulmonary edema.
- ECG: Broadening of QRS complex and evidence of ventricular strain with T wave changes. (Inverted 'T' waves in V5 & V6). Mild increase in left ventricular voltage. Exceptionally deep Q waves in lead III and V5 & V6.
- Echocardiography: Hypokinesia of left ventricle with diminished fractional shortening or ejection fraction.

Differential diagnosis
Acute myocarditis: A new case of dilated cardiomyopathy mimics acute myocarditis as both present with cardiomegaly and echocardiographic images are also similar. History of viral infection, increases in CPK enzymes are common with myocarditis.

Spontaneous improvement is common in both conditions and biopsy also is not conclusive in either case. So often, it is wiser to consider and manage patients of myocarditis similar to those as dilated cardiomyopathy.

Endocardial fibroelastosis: Echo shows bright endocardial echoes otherwise clinical manifestations are similar.

Aberrant left coronary artery: As clinical features and radiological features are same, echocardiography and angiocardiography helps to differentiate.

- Chest X-ray may be normal in early stages but later on left ventricle is enlarged with prominent left atrium
- ECG: Left ventricular hypertrophy with abnormal q waves in V5 & V6 due to septal hypertrophy.
- Echocardiography: Gross thickening of interventricular septum. Mitral valve echo shows systolic anterior movement of mitral valve. Normal injection fraction

Cardiomyopathy Cardiomyopathy 04/02/2001
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