N C Joshi
Dilated Cardiomyopthy (Congestive)
It is the commonest cardiomyopathy in children. Dilated cardiomyopathy is characterized by a reduction in systolic function of the ventricles with increased dilatation of the chambers. The characteristic echocardiographic appearance is of dilatation of left or both ventricular cavities with reduced contractility. It presents as newly diagnosed cardiac failure after infancy with tachycardia, tachypnea, pulmonary edema and/or elevated jugular venous pressure depending upon left or right ventricular involvement. A gallop rhythm is common and a murmur of mitral regurgitation may be audible. The etiology remains undiscovered, a past attack of myocarditis is most commonly considered as a cause.

Clinical presentation - Most children are referred for systolic murmur and are asymptomatic. Breathlessness, ischaemic cardiac pain and syncope are common in adolescence. Sudden death occurs in 15% of patients who are previously diagnosed.

Pulse is regular (may be irregular if patient is in atrial fibrillation) and of normal volume or often jerky (due to rapid ventricular ejection) in nature and JVP is not elevated. The cardiac apex is forceful and shows double impulse due to forceful presystolic impulse. An early systolic murmur with thrill at left lower sternal border conducted to aortic area is audible. 25% of patients may have systolic murmur due to mitral regurgitation.

Cardiomyopathy Cardiomyopathy 04/02/2001
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