Dilated Cardiomyopathy in Paediatric Population: A Review

Abstract

Dilated cardiomyopathy (DCM) is a common cardiac diagnosis in children that may result as a consequence of diverse genetic and environmental insults. The differential diagnosis remains quite broad and as a result the approach to diagnosis and management may, at times, be quite difficult. A rigorous work-up can exclude alternative causes of left ventricular (LV) dilation and dysfunction, identify etiologies that may respond to specific treatments, and guide family screening. Assessment of myocardial detection of pre-clinical DCM could significantly reduce morbidity and mortality by allowing early instigation of cardio protective therapy. This review article discusses genetic and acquired causes of DCM, diagnostic modalities and therapeutic implications in the hope of informing physicians of a clinical entity that afflicts a substantial number of children worldwide.
 Cardiovasc. j. 2019; 12(1): 64-74

Dilated Cardiomyopathy in Children: Early Detection and Treatment

“…Cardiomyopathies are a frequent cause of inpatient admission in hospitals and are the most typical cause of the need for heart transplantation procedures in patients of all age groups [15][16][17]. DCM in the pediatric age group is generally recognized by unobstructed, dilated, and contracting left ventricle defects and is associated with heart failure [18][19][20]. The usual causes of DCM include inflammation of the myocardium and neuromuscular disease.…”

“…The causes are usually indeterminate. There are fewer studies on the pathophysiology of this condition in the pediatric age group because of the comparatively small patient population and the unique challenges in separating other types of heart diseases associated with dilation of the ventricle chambers, namely endocardial fibroelastosis or myocarditis [20][21][22][23]. A significant chunk of the cases of genetic DCM was observed to be inherited in autosomal dominant patterns with variable expressivity and penetrance.…”

“…The evidence of viral myocarditis is common in children with DCM parvovirus B19, influenza, Ebstein-Barr virus, human immunodeficiency virus, coxsackie, herpes, and adenoviruses, which have all been found. Pediatric DCM is also observed to manifest after exposure to certain toxins, such as anthracyclines, during chemotherapy [ 20 ]. The causes are usually indeterminate.…”

“… Myocardial dysfunction can be caused by the persistence of a virus in the myocardium after a viral infection, an autoimmune process leading to lymphocytic myocarditis, or genetic mutations leading to structural protein abnormalities (which can further cause electrical abnormalities), leading to myocardial dysfunction that ultimately causes dilated cardiomyopathy [ 20 , 23 ]. …”