Definition and prognosis
Dilated cardiomyopathy (DCMO) refers to dilation and systolic dysfunction of the ventricles (predominantly the left ventricle) with or without congestive cardiac failure.
About a third of patients with DCMO improve, a third go on to develop chronic congestive heart failure and a third recover. Poor prognosis is associated with:
- Congenital DCMO
- DCMO related to storage diseases
- Post viral myocarditis in patients whose EF remains < 30% for more than 6 months
Palliative care considerations
DCMO is exacerbated by intercurrent infections with or without recovery to previous baseline or lower baseline and very few patients in South Africa have access to the possibility of cardiac transplantation. In addition, disease modifying drugs such as Entresto may modify the disease trajectory but are only available in certain centres of the country. In progressive and intractable cardiomyopathy, admissions become closer together and may increase in length and some patients get stuck in hospital on inotropes.