Chapter 15: Dilated Cardiomyopathy at the Crossroad: Multidisciplinary Approach

Patients with dilated cardiomyopathy (DCM) can present for the first time with typical cardiac symptoms, as heart failure, arrhythmias, and syncope, with cardiomyopathy as the main presenting feature. However, DCM may be a common feature of systemic diseases or presenting in the contest of different clinical settings. Symptoms of multisystem disease may be described by patients themselves or be determined on routine examination. A cardiomyopathy-specific mindset, which combines conventional cardiologic assessment with non-cardiac clinical acumen and a systematic approach, is important, because it can be used to identify specific disorders, guide rational selection of diagnostic tests, and increase the chance that disorders with tailored management strategies can be identified. Moreover, in different clinical settings, phenotypic expression in other organs may precede cardiac manifestations, and the cardiologist’s role is to search for cardiac involvement in a patient who already has a non-cardiac diagnosis. In the present chapter, we consider DCM and ventricular dysfunction in the contest of peculiar clinical settings ranging from inflammatory or autoimmune disorders to specific forms of systemic disease, infectious disease, as well as toxin-induced DCM.