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 ?
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 .
Final message
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
Reference
1.J Surg Educ. 2009 Mar-Apr;66(2):96-101. doi: 10.1016/j.jsurg.2008.11.004. Pheochromocytoma presenting as acute severe congestive heart failure, dilated cardiomyopathy, and severe mitral valvular regurgitation: a case report and review of the literature.
2.Kelley SR, Goel TK, Smith JM.Prog Cardiovasc Nurs. 2005 Summer;20(3):117-9. Pheochromocytoma presenting as heart failure.
3.Pheochromocytoma masquerading as a cardiomyopathy. Garcia R, Jennings JM. Am J Cardiol. 1972 Apr;29(4):568-71.
4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1894695/pdf/20070600s00025p244.pdf
5. http://downloads.hindawi.com/crim/medicine/2011/596354.pdf
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Dr.S.Venkatesan MD 