Etiological Definition and Diagnostic Work-Up

Dilated cardiomyopathy (DCM) is a heart muscle disease characterized by left ventricular or biventricular dilatation or systolic dysfunction without either pressure or volume overload or coronary artery disease sufficient to explain the dysfunction. It is pivotal to exclude possible removable causes of left ventricular dysfunction because this has prognostic implications. A comprehensive integrated approach, including third-level diagnostic tools, should be systematically implemented in clinical practice to remove every possible reversible cause through specific therapeutic interventions. This issue appears essential to promote left ventricular reverse remodeling and subsequent outcome improvement. Thus, the clinical approach to a suspected DCM requires a step-by-step work-up. In this chapter, we dissect the “red flags approach” to DCM with particular focus on easily missed diagnosis.