Initial Evaluation of Cardiomyopathy

Initial Evaluation of Cardiomyopathy

Clinical Evaluation

Thorough history and physical examination to identify cardiac and noncardiac disorders^a

Detailed family history of heart failure, cardiomyopathy, skeletal myopathy, conduction disorders and tachyarrhythmias, sudden death

History of alcohol, illicit drugs, chemotherapy, or radiation therapy^a

Assessment of ability to perform routine and desired activities^a

Assessment of volume status, orthostatic blood pressure, body mass index^a

Laboratory Evaluation

Electrocardiogram^a

Chest radiograph^a

Two-dimensional and Doppler echocardiogram^a

Magnetic resonance imaging to assess myocardial inflammation and fibrosis

Chemistry:

Serum sodium,^a potassium,^a calcium,^a magnesium^a

Fasting glucose (glycohemoglobin in DM)

Creatinine, ^a blood urea nitrogen^a

Albumin,^a total protein,^a liver function tests^a

Lipid profile

Thyroid-stimulating hormone^a

Serum iron, transferrin saturation

Urinalysis

Hematology:

Hemoglobin/hematocrit^a

White blood cell count with differential,^a including eosinophils

Erythrocyte sedimentation rate

Initial Evaluation Only in Pts Selected for Possible Specific Diagnosis

Titers for infection in presence of clinical suspicion:

Acute viral (e.g., coxsackievirus, echovirus, influenza virus)

Human immunodeficiency virus,

Chagas' disease, Lyme disease, toxoplasmosis

Catheterization with coronary angiography in pts with angina who are candidates for intervention^a

Serologies for active rheumatologic disease

Endomyocardial biopsy including sample for electron microscopy when suspecting specific diagnosis with therapeutic implications

Screening for sleep-disordered breathing

^aLevel I Recommendations from ACC/AHA Practice Guidelines for Chronic Heart Failure in the adult.

Source: From SA Hunt et al: Circulation 112: 2005.