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KEY FEATURES

ESSENTIALS OF DIAGNOSIS

  • Typical dilated cardiomyopathy with reduced systolic function

  • Atrial or ventricular tachycardia or frequent ventricular ectopy (>10,000 to 25,000 premature ventricular contractions per 24 hours)

GENERAL CONSIDERATIONS

  • Atrial tachyarrhythmias with persistently elevated ventricular rates (120–180 bpm) can lead to progressive left ventricle dilatation and systolic dysfunction

  • The cardiomyopathy develops slowly (over months or longer)

  • The mechanism of tachycardia cardiomyopathy is poorly understood, but it can be created in animals by rapid atrial and ventricular pacing

  • The hallmark of disease is partial or complete reversibility once the arrhythmia is controlled

CLINICAL PRESENTATION

SYMPTOMS AND SIGNS

  • Typical symptoms of chronic heart failure, such as exertional dyspnea, exercise intolerance, chest discomfort, orthopnea, paroxysmal nocturnal dyspnea, and weight gain

  • There is no specific heart rate cutoff that predisposes to cardiomyopathy

PHYSICAL EXAM FINDINGS

  • Typical findings of chronic heart failure, such as elevated jugular venous pressure, extra heart sounds (S3 or S4), pulmonary rales, peripheral edema

  • Supraventricular tachycardia, ventricular tachycardia, or frequent ventricular ectopy

DIFFERENTIAL DIAGNOSIS

  • Dilated cardiomyopathy of another etiology should be suspected if left ventricular function does not improve with control or termination of the tachyarrhythmia

DIAGNOSTIC EVALUATION

LABORATORY TESTS

  • Electrolytes, creatinine, brain natriuretic peptide

IMAGING STUDIES

  • Chest x-ray

    • – Pulmonary edema with cardiomegaly

  • Echocardiography

    • – Dilated, hypokinetic left ventricle

    • – Functional mitral regurgitation, tricuspid regurgitation, and mildly elevated pulmonary pressures on Doppler

DIAGNOSTIC PROCEDURES

  • Coronary angiography may be necessary in some cases to exclude other causes of heart failure and coronary artery disease

TREATMENT

CARDIOLOGY REFERRAL

  • Suspected tachycardia cardiomyopathy

HOSPITALIZATION CRITERIA

  • Decompensated heart failure

MEDICATIONS

  • Pharmacologic therapy to eliminate or control the arrhythmia

  • Pharmacologic therapy to prevent the arrhythmia

  • Guideline-directed medical therapy for chronic heart failure

THERAPEUTIC PROCEDURES

  • Cardioversion of ventricular tachycardia, atrial fibrillation, or atrial flutter

  • Catheter ablation of tachyarrhythmia

MONITORING

  • ECG in hospital as appropriate

DIET AND ACTIVITY

  • Low-sodium diet

  • Restricted activity until problem corrected

ONGOING MANAGEMENT

HOSPITAL DISCHARGE CRITERIA

  • Resolution of heart failure

  • Successful ablation

FOLLOW-UP

  • Depends on therapy

COMPLICATIONS

  • Death, cardiac arrest

  • Pulmonary edema

  • Antiarrhythmic drug toxicity

  • Complications surrounding catheter ablation

PROGNOSIS

  • Excellent with prompt, effective treatment

PREVENTION

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