What are causes of dilated cardiomyopathy?

Updated: Mar 02, 2021
  • Author: Vinh Q Nguyen, MD, FACC; Chief Editor: Gyanendra K Sharma, MD, FACC, FASE  more...
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Dilated cardiomyopathy has many causes, including inherited disease, infections, and toxins. A systematic approach to define the etiology is essential for determination of the most effective treatment strategy.

Causes of dilated cardiomyopathy include the following:

  • Heredity

  • Secondary to other cardiovascular disease: ischemia, hypertension, valvular disease, tachycardia induced

  • Infectious: viral, rickettsial, bacterial, fungal, metazoal, protozoal

  • Probable infectious: Whipple disease, Lyme disease

  • Metabolic: endocrine diseases (eg, hyperthyroidism, hypothyroidism, acromegaly, myxedema, hypoparathyroidism, hyperparathyroidism), diabetes mellitus, electrolyte imbalance (eg, potassium, phosphate, magnesium), pheochromocytoma

  • Rheumatologic/connective tissue disorders: scleroderma, rheumatoid arthritis, systemic lupus erythematosus

  • Nutritional: thiamine deficiency (beriberi), protein deficiency, starvation, carnitine deficiency

  • Toxic: drugs (eg, antineoplastic/anthracycline agents, vascular endothelial growth factor [VEGF] inhibitors), poisons, foods, anesthetic gases, heavy metals, ethanol

  • Collagen vascular disease

  • Infiltrative: hemochromatosis, amyloidosis, glycogen storage disease

  • Granulomatous (sarcoidosis, giant cell myocarditis)

  • Physical agents: extreme temperatures, ionizing radiation, electric shock, nonpenetrating thoracic injury

  • Neuromuscular disorders: muscular dystrophy (limb-girdle [Erb dystrophy], Duchenne dystrophy, fascioscapulohumeral [Landouzy-Dejerine dystrophy]), Friedreich disease, myotonic dystrophy

  • Primary cardiac tumor (myxoma)

  • Senile

  • Peripartum

  • Immunologic: postvaccination, serum sickness, transplant rejection

  • Stress-induced cardiomyopathy (Takotsubo cardiomyopathy)

In many cases of dilated cardiomyopathy, the cause remains unexplained. However, some idiopathic cases may result from failure to identify known causes such as infections or toxins. The idiopathic category should continue to diminish as more information explaining pathophysiologic mechanisms, specifically genetic-environmental interactions, becomes available.

Toxins are a significant cause. Almost a third of cases may result from severe ethanol abuse (>90 grams/day, or 7 to 8 drinks per day) for more than 5 years.

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