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Dilated cardiomyopathy may be suspected if a patient visits a physician complaining of increasing fatigue and difficulty exercising.
The first step that a physician will take when diagnosing dilated cardiomyopathy is to obtain the patient’s personal and family medical history. In particular, the physician will look for family members who have this or other cardiac disorders, such as myocarditis. The patient will be given a complete physical examination with particular focus on the heart and lungs. The physician will listen for crackles in the patient’s lungs, a heart murmur or other unusual sounds. The physician will also take the patient’s pulse rate and blood pressure.
To help diagnose any cardiac abnormalities, the physician may order one or more tests to look for the cause of the patient’s symptoms. These tests include the following:
- Echocardiogram. A painless test that uses sound waves to visualize the structures and functions of the heart. A moving image of the patient’s beating heart is played on a video screen, where a physician can study the heart’s thickness, size and function. From this image, a physician can measure the heart’s size, pumping ability and ejection fraction, which tend to be abnormal in people with cardiomyopathies. The image also shows the motion pattern and structure of the four heart valves, revealing any potential leakage (regurgitation) or narrowing (stenosis). During this test, a Doppler ultrasound may be done to evaluate cardiac blood flow.
- Chest x-ray. A painless, radiation-based imaging test that offers the physician a picture of the general size, shape, and structure of the heart and lungs.
- Electrocardiogram (EKG). A painless test that measures the heart’s electrical activity, aiding in the assessment of any abnormal heart rhythms (arrhythmias) or an enlarged heart.
- Stress tests. These come in various forms, but the most common includes exercising on a treadmill or stationary bike while an EKG measures the heart’s electrical activity. The patient will be asked to exercise until a target heart rate is reached. The heart is then monitored while it is under this stress.
- CAT scan (computed axial tomography). Also known as a CT scan, this painless test allows for multiple x-rays to be taken from different angles around the patient. With the help of a computer, a three-dimensional image can be created. It may reveal a larger-than-normal heart.
- “Fast” MRI (magnetic resonance imaging). Advances in MRI scans have resulted in crisper resolutions of blood flow, ejection fraction, stroke volume (the amount of blood ejected with each heartbeat) and scar tissue in the heart.
In some cases, the physician may need to order more invasive tests, such as a biopsy of the heart, to tell the difference between a dilated cardiomyopathy and similar forms of heart disease. A cardiac catheterization, with a left ventriculogram, may also be necessary.
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