Effective management of congestive cardiomyopathy. Relation to ventricular structure and function

Until recently, congestive cardiomyopathy has had a poor prognosis on standard treatment because of severe congestive failure, arrhythmias, and embolism from endocardial thrombi in both ventricles. This pluricausal disorder differs from other heart disease because of disproportionately small hypertrophy in relation to ventricular dilation, with ultimate severe impairment of systolic function. Absence of hypertrophy adequate to compensate dilation exaggerates ventricular wall stress beyond that seen in other disorders. Newer treatments seeming to promise unprecedented improvement include unloading therapy with vasodilators, nonglycoside inotropic therapy, beta-adrenoceptor blockade (experimental only), combinations of these agents with or without digitalis and diuretics, and intra-aortic balloon pumping for critical failure. New surgical approaches include mitral annuloplasty, coronary bypass (for ischemic cardiomyopathy), and, for appropriate recipients, cardiac transplantation.