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Dilated Cardiomyopathy

Dilated cardiomyopathy (DCM)

Cardiomyopathy
Dilated Cardiomyopathy
ECG and Dilated Cardiomyopathy

Cardiomyopathy

Cardiomyopathy (CMP) is a group of diseases that primarily affect the myocardium
We recognize 3 main types of cardiomyopathy:

Dilated cardiomyopathy involves dilation mainly of the left ventricle
Hypertrophic cardiomyopathy is characterized by hypertrophy mainly of the ventricular septum
Restrictive cardiomyopathy features a rigid, "stiffened" myocardium

Sometimes cardiomyopathy includes:

Arrhythmogenic right ventricular dysplasia is characterized by fatty replacement of the right ventricular myocardium
Takotsubo cardiomyopathy occurs in women under stress, leading to hyperkinesis of the base and akinesis of the apex of the heart

Physiological Myocardium

Ventricles are of normal size

Dilated Cardiomyopathy

is dilation mainly of the left ventricle

Hypertrophic Cardiomyopathy

is hypertrophy mainly of the ventricular septum

Restrictive Cardiomyopathy

myocardium is rigid, "stiffened"

Dilated Cardiomyopathy

It is dilation mainly of the left ventricle, sometimes also the right

The heart ceases to function as a pump, ejection fraction drops below 40%

Etiology of Dilated Cardiomyopathy:

Ischemic Etiology

Dilated cardiomyopathy occurs after a massive anterior wall infarction

Non-Ischemic Etiology

Idiopathic (arising from unknown causes)
Genetic (familial occurrence)

Other etiologies: viral infections, alcohol, autoimmune diseases

ECG and Dilated Cardiomyopathy

Dilated Cardiomyopathy (DCM) does not have diagnostic criteria on ECG

ECG is always abnormal in DCM
Diagnosis is made using echocardiography

Most Common ECG Changes in Dilated Cardiomyopathy

Left Ventricular Hypertrophy (ECG signs of hypertrophy also occur in dilation)
Left Tawar Branch Block (more common than right bundle branch block)

Right Tawar Branch Block

Ventricular Conduction Disorder
Pathological Q Waves (V1-V4) (may resemble a past myocardial infarction)
Decreased Progression of R Waves
Negative T Waves
Ventricular Tachycardia (ventricles are structurally altered, providing a substrate for tachycardia)
AV Block I (ventricular dilation may damage the AV node)
Left Atrial Hypertrophy (ventricular end-diastolic overload leads to atrial dilation)
Atrial Fibrillation (occurs in structurally altered atria)
Sinus Tachycardia (in heart failure, there is increased sympathetic tone)

Dilated Cardiomyopathy

Biventricular Hypertrophy

Left Ventricular Hypertrophy (Sokolow index > 35mm)
Right Ventricular Hypertrophy (Right Axis Deviation)

Bilateral Atrial Hypertrophy

P Mitrale (Left Atrial Hypertrophy) (P wave in V1 is deeper than 1mm)
P Pulmonale (Right Atrial Hypertrophy) (P wave in II is approximately 2.5mm)

The patient had dilatation of the atria and ventricles on echocardiography
The cause of the dilated cardiomyopathy was ischemic heart disease

Dilated Cardiomyopathy

Left Ventricular Hypertrophy (Sokolow index > 35mm)

Left Ventricular Overload (ST depression in I, II, V5, V6)

Bilateral Atrial Hypertrophy (large positive and negative amplitude of P wave in V1)
The patient had dilatation of both the atria and ventricles on echocardiography

Right Ventricular Hypertrophy is masked by left ventricular hypertrophy on EKG
The patient had idiopathic dilated cardiomyopathy

Dilated Cardiomyopathy

Left Ventricular Hypertrophy (Sokolow index > 35mm)
Right Ventricular Hypertrophy (Axis deviation to the right)
Prolonged Ventricular Conduction (QRS width > 0.12s)

Small Q wave (V5-6) rules out Left Bundle Branch Block

Discordant ST Depression (II, III, aVF, V5, V6) may be seen in

Left Ventricular Overload
Use of digoxin

Dilated Cardiomyopathy

Left Ventricular Hypertrophy (Sokolow index > 35mm)

Left Ventricular Overload (ST Depression in aVL, V5, V6)

Left Anterior Fascicular Block (Axis deviation to the left)
Atrial Fibrillation

P waves are not visible
Heart rate is irregularly irregular

Left Bundle Branch Block

Wide QRS complex > 0.12s
Deep S (V1), Dominant R (V6)

Sources

ECG from Basics to Essentials Step by Step
litfl.com
ecgwaves.com
metealpaslan.com
medmastery.com
uptodate.com
ecgpedia.org
wikipedia.org
Strong Medicine
Understanding Pacemakers

Home /

Dilated Cardiomyopathy

Dilated cardiomyopathy (DCM)

Cardiomyopathy
Dilated Cardiomyopathy
ECG and Dilated Cardiomyopathy

Cardiomyopathy

Cardiomyopathy (CMP) is a group of diseases that primarily affect the myocardium
We recognize 3 main types of cardiomyopathy:

Dilated cardiomyopathy involves dilation mainly of the left ventricle
Hypertrophic cardiomyopathy is characterized by hypertrophy mainly of the ventricular septum
Restrictive cardiomyopathy features a rigid, "stiffened" myocardium

Sometimes cardiomyopathy includes:

Arrhythmogenic right ventricular dysplasia is characterized by fatty replacement of the right ventricular myocardium
Takotsubo cardiomyopathy occurs in women under stress, leading to hyperkinesis of the base and akinesis of the apex of the heart

Physiological Myocardium

Ventricles are of normal size

Dilated Cardiomyopathy

is dilation mainly of the left ventricle

Hypertrophic Cardiomyopathy

is hypertrophy mainly of the ventricular septum

Restrictive Cardiomyopathy

myocardium is rigid, "stiffened"

Dilated Cardiomyopathy

It is dilation mainly of the left ventricle, sometimes also the right

The heart ceases to function as a pump, ejection fraction drops below 40%

Etiology of Dilated Cardiomyopathy:

Ischemic Etiology

Dilated cardiomyopathy occurs after a massive anterior wall infarction

Non-Ischemic Etiology

Idiopathic (arising from unknown causes)
Genetic (familial occurrence)

Other etiologies: viral infections, alcohol, autoimmune diseases

ECG and Dilated Cardiomyopathy

Dilated Cardiomyopathy (DCM) does not have diagnostic criteria on ECG

ECG is always abnormal in DCM
Diagnosis is made using echocardiography

Most Common ECG Changes in Dilated Cardiomyopathy

Left Ventricular Hypertrophy (ECG signs of hypertrophy also occur in dilation)
Left Tawar Branch Block (more common than right bundle branch block)

Right Tawar Branch Block

Ventricular Conduction Disorder
Pathological Q Waves (V1-V4) (may resemble a past myocardial infarction)
Decreased Progression of R Waves
Negative T Waves
Ventricular Tachycardia (ventricles are structurally altered, providing a substrate for tachycardia)
AV Block I (ventricular dilation may damage the AV node)
Left Atrial Hypertrophy (ventricular end-diastolic overload leads to atrial dilation)
Atrial Fibrillation (occurs in structurally altered atria)
Sinus Tachycardia (in heart failure, there is increased sympathetic tone)

Dilated Cardiomyopathy

Biventricular Hypertrophy

Left Ventricular Hypertrophy (Sokolow index > 35mm)
Right Ventricular Hypertrophy (Right Axis Deviation)

Bilateral Atrial Hypertrophy

P Mitrale (Left Atrial Hypertrophy) (P wave in V1 is deeper than 1mm)
P Pulmonale (Right Atrial Hypertrophy) (P wave in II is approximately 2.5mm)

The patient had dilatation of the atria and ventricles on echocardiography
The cause of the dilated cardiomyopathy was ischemic heart disease

Dilated Cardiomyopathy

Left Ventricular Hypertrophy (Sokolow index > 35mm)

Left Ventricular Overload (ST depression in I, II, V5, V6)

Bilateral Atrial Hypertrophy (large positive and negative amplitude of P wave in V1)
The patient had dilatation of both the atria and ventricles on echocardiography

Right Ventricular Hypertrophy is masked by left ventricular hypertrophy on EKG
The patient had idiopathic dilated cardiomyopathy

Dilated Cardiomyopathy

Left Ventricular Hypertrophy (Sokolow index > 35mm)
Right Ventricular Hypertrophy (Axis deviation to the right)
Prolonged Ventricular Conduction (QRS width > 0.12s)

Small Q wave (V5-6) rules out Left Bundle Branch Block

Discordant ST Depression (II, III, aVF, V5, V6) may be seen in

Left Ventricular Overload
Use of digoxin

Dilated Cardiomyopathy

Left Ventricular Hypertrophy (Sokolow index > 35mm)

Left Ventricular Overload (ST Depression in aVL, V5, V6)

Left Anterior Fascicular Block (Axis deviation to the left)
Atrial Fibrillation

P waves are not visible
Heart rate is irregularly irregular

Left Bundle Branch Block

Wide QRS complex > 0.12s
Deep S (V1), Dominant R (V6)

Sources

ECG from Basics to Essentials Step by Step
litfl.com
ecgwaves.com
metealpaslan.com
medmastery.com
uptodate.com
ecgpedia.org
wikipedia.org
Strong Medicine
Understanding Pacemakers