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Editorials

Coronary Artery or Myocyte

Wherein Lies the Diagnosis?

Subha V. Raman, MD, MSEE

From The Ohio State University, Columbus, Ohio.

Correspondence to Subha V. Raman, MD, MSEE, The Ohio State University, 473 W 12th Ave, Suite 200, Columbus, OH 43210. E-mail raman.1@osu.edu

Key Words: Editorials • myocardial disease • chronic ischemic heart disease • coronary imaging • computed tomography • magnetic resonance imaging

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Concision in style, precision in thought, decision in life.

— —Victor Hugo, 1907*

Patients who have left ventricular (LV) contractile dysfunction with dilatation of one or both ventricles receive the broad diagnosis of dilated cardiomyopathy (DCM), though further refinement is invariably required to guide appropriate therapy. Etiologic considerations span metabolic, toxic, infiltrative, structural, and congenital disorders, many of which may be apparent on initial history; hypertension and atherosclerotic coronary artery disease (CAD) are often the lead suspects (Table). Even in the absence of a defined genetic syndrome, DCM often occurs within a milieu of genetic susceptibility, underscoring the need to elicit a careful family history.

Article see p 199

If bedside assessment does not point to an obvious etiology, the initial workup of newly diagnosed DCM typically includes one or more diagnostic procedures. The ECG has proven utility amidst an array of imaging options for the patient with DCM, even if the merit of Q waves in defining infarcted myocardium has waned. Recognition of epsilon waves should promote consideration of arrhythmogenic right ventricular cardiomyopathy,¹ atrioventricular block with the appropriate family history should trigger suspicion of lamin A/C cardiomyopathy,² and low QRS voltage despite thickened myocardium should raise one’s suspicion of amyloidosis.³

View this table:   Table. Causes of Cardiomyopathy

 
Accurate diagnosis in the initial workup of DCM dictates distinct treatment pathways and attendant variability in prognosis. Excluding CAD in the patient with newly diagnosed DCM holds particular import, as dysfunction caused by hibernating myocardium may improve considerably with revascularization. Conversely, patients with . . . [Full Text of this Article]

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