Dilated cardiomyopathy in children

Dilated cardiomyopathy is a myocardial disease characterized by a sharp expansion of the heart cavities, a decrease in the contractile function of the myocardium, the development of congestive heart failure, often refractory to treatment, and a poor prognosis.

ICD-10 code

142.0 Dilated cardiomyopathy.

Epidemiology

Dilated cardiomyopathy in children is one of the most common clinical forms of cardiomyopathy, it is found in most countries of the world and at any age. The true frequency of dilated cardiomyopathy in children is unknown due to the lack of uniform diagnostic criteria for the disease. According to various authors, the incidence among children is 5-10 cases per 100,000 population. Almost all studies note the predominance of male patients (62-88%).

Causes and pathogenesis of dilated cardiomyopathy

Various hypotheses have been put forward regarding the origin of dilated cardiomyopathy; however, in recent years, the opinion has increasingly been expressed about the multifactorial genesis of the disease.

The development of dilated cardiomyopathy is based on the disruption of systolic and diastolic functions of the myocardium with subsequent dilation of the heart cavities, caused by damage to cardiomyocytes and the formation of replacement fibrosis under the influence of various factors (toxic substances, pathogenic viruses, inflammatory cells, autoantibodies, etc.).

Causes and pathogenesis of dilated cardiomyopathy

Symptoms of dilated cardiomyopathy

The clinical picture of dilated cardiomyopathy is variable and depends mainly on the severity of circulatory failure. In the early stages, the disease is asymptomatic or asymptomatic, subjective manifestations are often absent, children do not complain. Cardiomegaly, changes in the ECG are often detected accidentally during preventive examinations or when visiting a doctor for another reason. This explains the late detection of the pathology.

Symptoms of dilated cardiomyopathy

Diagnosis of dilated cardiomyopathy

Diagnosis of dilated cardiomyopathy is difficult, since the disease has no specific criteria. The final diagnosis of dilated cardiomyopathy is established by excluding all diseases that can lead to enlargement of the heart cavities and circulatory failure. The most important element of the clinical picture in patients with dilated cardiomyopathy is episodes of embolism, which very often lead to death of patients.

The survey plan is as follows.

• Collection of life history, family history, and disease history.
• Clinical examination.
• Laboratory research.
• Instrumental studies (echocardiography, ECG, Holter monitoring, chest X-ray, ultrasound examination of the abdominal organs and kidneys).

Diagnosis of dilated cardiomyopathy

Treatment of dilated cardiomyopathy

Along with innovations in the pathogenesis of dilated cardiomyopathy, the last decade has been marked by the emergence of new views on its therapy, but to date, treatment remains mainly symptomatic. Therapy is based on the correction and prevention of the main clinical manifestations of the disease and its complications: chronic heart failure, cardiac arrhythmias, and thromboembolism.

Treatment of dilated cardiomyopathy

Prognosis for dilated cardiomyopathy

The prognosis of the disease is very serious, although there are isolated reports of significant improvement in the clinical condition of patients with conventional therapy.

The prognosis criteria include the duration of the disease after diagnosis, clinical symptoms and severity of heart failure, the presence of a low-voltage type of electrocardiogram. high-grade ventricular arrhythmias, the degree of reduction in contractile and pumping functions of the heart. The average life expectancy of patients with dilated cardiomyopathy is 3.5-5 years. The opinions of various authors differ when studying the outcome of dilated cardiomyopathy in children. The highest survival rate is noted among young children.

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