Ignorance at it’s best :The Adrenal connection of dilated cardiomyopathy ?
Posted Dec 24 2012 10:55pm
The popular clinical entity Idiopathic dilated cardiomyopathy is often a “dust-bin diagnosis” . The fact is the word idiopathic simply reflects our ignorance.
For God nothing is idiopathic . . . he knows how each and every cell would behave .
so , when a patient presents with progressive dilatation and heart failure refractory to all medical therapy he is termed as idiopathic and posted for heart transplantation. And only later , we realize the whole thing is due a terrible form of reversible DCM . That is pheochromocytoma induced DCM , which recurred again in the transplanted heart. What a costly Ignorance ?
Image courtesy and source .
Is sub- clinical pheo like situations rampant ?
We know that high levels of both epi and nor- epinephrine circulate in cardiac failure . We presume it to be a secondary effect .
How can we so sure about it ? There is a distinct possibility of adrenal gland hyperfunction and hyperplasia in all DCMs (Idiopathic or ischemic ! ) The dramatic beneficial effects of beta blockers in cardiac failure will vouch for it .
So , It remains a fertile filed for the youngsters to explore . . . the hyper adrenergic mediated reversible component of any cardiomyopathy and cardiac failure .
The default approach in any patient with progressive / refractory cardiac failure should be , to consider whether they fit into any form of reversible myocardial disease . What is idiopathic in remote clinic of your distant country side may be well recognized secondary cardiomyopathy . The irony is , even sophisticated university hospitals many times miss the true etiology as in the above case report .
So, the term Idiopathic dilated cardiomyopathy (iDCM ) may aptly be named as Ignorant forms of DCM , with an attractive abbreviation . . . iDCM