Dilated Cardiomyopathy

Episode overview

Dilated cardiomyopathy is a major cause of heart failure with reduced ejection fraction characterized by ventricular dilation and impaired contractility. In this episode, Chris and Mars review the “big ventricle, weak squeeze” physiology of dilated cardiomyopathy, classic causes including alcohol, myocarditis, anthracyclines, genetic disease, peripartum cardiomyopathy, and tachycardia-mediated cardiomyopathy, key examination and echocardiographic findings, how to distinguish dilated cardiomyopathy from ischemic, valvular, hypertrophic, and restrictive disease, the role of cardiac MRI and genetic evaluation, the four foundational medications for HFrEF, why reversible causes must be identified early, ventricular arrhythmias, sudden cardiac death, and left ventricular mural thrombus, and why first-degree relatives may need cardiac and genetic screening. Episode pearl: A dilated, poorly contracting ventricle gives you the diagnosis pattern—but the next question should always be: why did it become dilate?