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Table 117-1

Presentation with Symptomatic Cardiomyopathy

DILATEDRESTRICTIVEHYPERTROPHIC
Ejection fraction (normal >55%)Usually <30% when symptoms severe25-50%>60%
Left ventricular diastolic dimension (normal <55 mm)≥60 mm<60 mm (may be decreased)Often decreased
Left ventricular wall thicknessNormal or decreasedNormal or increasedMarkedly increased
Atrial sizeIncreasedIncreased; may be massiveIncreased
Valvular regurgitationRelated to annular dilationRelated to endocardial involvement; frequent mitral and tricuspid regurgitation, rarely severeRelated to valve-septum interaction: mitral regurgitation
Common first symptomsExertional intoleranceExertional intolerance, fluid retention earlyExertional intolerance; may have chest pain
Congestive symptomsa Left before right, except right prominent in young adultsRight often dominatesLeft-sided congestion may develop late
ArrhythmiaVentricular tachyarrhythmia; conduction block in Chagas' disease, and some familial forms. Atrial fibrillationVentricular uncommon except in sarcoidosis, conduction block in sarcoidosis and amyloidosis. Atrial fibrillationVentricular tachyarrhythmias; atrial fibrillation

a Left-sided symptoms of pulmonary congestion: dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea. Right-sided symptoms of systemic venous congestion: hepatic and abdominal distention, discomfort on bending, peripheral edema.