Synopsis
Recognise the DCM phenotype, find reversible and inherited causes, treat heart failure and prevent arrhythmic death.
- DCM is LV or biventricular dilatation with systolic dysfunction not explained solely by abnormal loading or coronary disease.
- A normal coronary angiogram identifies non-ischaemic dysfunction; it does not establish an idiopathic diagnosis.
- Ask specifically about family sudden death, alcohol, pregnancy, myocarditis, chemotherapy, toxins and neuromuscular features.
Key red flags
Unexplained syncope, sustained VT, extensive scar, severe biventricular failure or progressive conduction block signals risk beyond symptoms or LVEF alone.
Investigation priorities
Detect AF, conduction disease and ventricular arrhythmia.
Management branches
Pulmonary oedema, hypoperfusion or serious arrhythmia.
- Assess ABCDE, continuous ECG, oxygen only if hypoxaemic, IV access, renal/electrolytes, troponin/NT-proBNP and urgent bedside echo.
- Treat congestion with IV loop diuretic; if shock persists, escalate immediately to critical care and an advanced-heart-failure centre for inotrope or mechanical-support assessment.
Stable DCM after congestion is controlled.
Key medicines
Dapagliflozin10 mg orally once daily for chronic HFrEF.
SpironolactoneUsually 25 mg orally once daily; reduce or titrate according to renal function, potassium and response.