DILATED CARDIOMYOPATHY

It is becoming increasingly apparent that systolic dysfunction is not the only myocardial abnormality of patients with dilated cardiomyopathy. Many of the clinical findings in patients with systolic dysfunction are secondary to diastolic dysfunction or to changes in skeletal muscle physiology. Fortunately, the natural course of dilated cardiomyopathy can be altered by therapeutic interventions. Not only can converting enzyme inhibitors prevent the inexorable downhill course associated with cardiac dysfunction, but blockade of the adrenergic system may also be beneficial. Nevertheless, survival studies continue to demonstrate a high incidence of sudden death despite optimal treatment of congestive heart failure. Even interventions designed to prevent arrhythmic deaths have not yet been demonstrated to be of benefit. Ongoing studies should help elucidate new means of altering the course of patients with dilated cardiomyopathy.