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Dilated Cardiomyopathy 263

trial if initial testing results were unremarkable. • Small, frequent meals (3-6 times/day) PEARLS & CONSIDERATIONS
Unsuccessful trial should prompt a change of • Elimination diet: novel protein source or Comments
VetBooks.ir Acute and Chronic Treatment (avoid chewable medications); at least 2-3 Avoid indiscriminant use of antibiotics because Diseases and Disorders
hydrolyzed protein diet as sole food source
course (diagnostic or therapeutic).
they alter microbiome and promote emergence
weeks
Depends on underlying cause. Empirical
therapy often includes anthelmintics, dietary • Pancreatitis/EPI/lymphangiectasia/PLE: of resistance bacteria.
highly digestible and low-fat diet
trials, probiotics/prebiotics, antimicrobials • Colitis: high soluble fiber Technician Tips
(metronidazole, tylosin, enrofloxacin [boxer, Proper hygiene is vital to avoid contagion/
French bulldog colitis]), cobalamin, immu- Possible Complications zoonoses (handwashing between patients, gloves
nomodulators, or antiinflammatories. • Excessive protein loss: peripheral edema, when cleaning a patient with diarrhea, avoid
• Anthelmintic (e.g., fenbendazole 50 mg/kg cavity effusions human food in clinic).
PO q 24h × 3 days, repeated 3 weeks later) • Pancreatic enzyme supplementation (EPI):
• Elimination/hypoallergenic diet trial (p. 347) buccal mucosal irritation Client Education
• Probiotics/prebiotics (p. 260) • Iatrogenic hyperadrenocorticism; use Treatment for some causes of diarrhea can be
• Cobalamin supplementation (p. 183) minimum effective glucocorticoid dose frustrating. Client communication is essential to
• Antimicrobials (see specific organism). avoid unrealistic expectations/disappointment.
Possible immunomodulating and antiinflam- Recommended Monitoring
matory activities (metronidazole and tylosin) Body weight, body condition score, fecal con- SUGGESTED READING
• Immunosuppressive agents best if histologi- sistency, serum protein/albumin concentrations, Marks SL: Diarrhea. In Washabau RJ, et al, editors:
cally proven inflammatory bowel disease (p. CBC (immunosuppressive agents) Canine and feline gastroenterology, St. Louis, 2013,
543) Saunders, pp 99-108.
PROGNOSIS & OUTCOME
Nutrition/Diet AUTHOR: Lisa Carioto, DVM, DVSc, DACVIM
Consultation with a veterinary nutritionist may Depends on underlying cause, response to EDITOR: Leah A. Cohn, DVM, PhD, DACVIM
be beneficial, especially if there are comorbidi- treatment, owner compliance, and individual
ties with additional nutritional implications. variation

Dilated Cardiomyopathy Client Education
Sheet

BASIC INFORMATION boxer, Afghan hound, Old English sheepdog, • Nutritional
Dalmatian ○ A DCM phenotype has been associated
Definition ○ Size exceptions are American and English with certain grain-free diets.
Dilated cardiomyopathy (DCM) is a myocardial cocker spaniels. • Toxic: doxorubicin (and other anthracycline
systolic dysfunction disorder (primary or second- • Doberman pinschers: lifetime risk of 58.2% chemotherapeutic agents); low incidence
2
ary) leading to phenotypic ventricular dilation with an autosomal dominant pattern ○ Cumulative doses > 180 mg/m at greatest
(left > right ventricle), diastolic dysfunction, and ○ Two mutations identified in affected risk
atrial enlargement and causing congestive heart Dobermans: PDK4 and DCM2 ○ Dogs can be affected at lower doses; screen-
failure (CHF), arrhythmias, or both. ○ Each mutation can independently lead to ing before treatment is recommended
development of DCM. Cats:
Synonyms ○ Dogs affected with both mutations are • Taurine-deficient diets
• Primary: idiopathic DCM 30 times more likely to develop DCM. • End-stage restrictive cardiomyopathy (RCM)
• Secondary: nutritional cardiomyopathy, toxic • Great Danes: 25% prevalence and hypertrophic cardiomyopathy (HCM)
cardiomyopathy, end-stage myocarditis ○ X-linked, recessive; males (affected) > can result in a DCM phenotype.
females (carriers) • Idiopathic DCM is rare in the cat.
Epidemiology • Golden retriever (Duchenne muscular
SPECIES, AGE, SEX dystrophy, rare) CONTAGION AND ZOONOSIS
Dogs: ○ X-linked • Myocarditis is a secondary cause of pheno-
• Adult onset most common; (4-10 years of • Boxers: arrhythmogenic right ventricular typic DCM.
age) cardiomyopathy (p. 76) • Usually a rare cause of systolic dysfunction,
• Early onset ○ Autosomal dominant but a DCM phenotype can occur at end
○ Standard schnauzer (1-2 years) • Portuguese water dog: autosomal recessive stage of myocarditis.
○ Portuguese water dog (2-32 weeks) • Irish wolfhound (sex-specific alleles); male • Arrhythmias are more common than systolic
○ Toy Manchester terrier (10-58 weeks) > female dysfunction (p. 675).
Cats: Cats: reported overrepresentation in Persian,
• Adult onset (2-16 years; median, 9.5 years) domestic shorthair and long hair, Abyssinian, GEOGRAPHY AND SEASONALITY
Birman, Burmese, Siamese cats See Myocarditis, Section 1 (p. 675).
GENETICS, BREED PREDISPOSITION
Dogs: RISK FACTORS ASSOCIATED DISORDERS
• Large-breed dogs (>20 kg) overrepresented: Dogs: Congestive heart failure, arrhythmia
Doberman pinscher, Irish wolfhound, Great • Idiopathic
Dane, Newfoundland, Scottish deerhound, ○ Large breed dogs (>20 kg)

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