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Clinical Features and Therapeutic Strategy of Dilated Cardiomyopathy in 36 Children

YANG Xi,LIU Gui-ying(Department of Pediatrics,Beijing Anzhen Hospital Affiliated to Capital Medical University,Beijing 100029,China)  
Objective To explore the clinical features,therapeutic effect and prognosis of dilated cardiomyopathy(DCM) in children.Methods The data of 36 children with DCM in Beijing Anzhen Hospital were analyzed,including clinical manifestations,biomarkers,electrocardiogram,X-ray,echocardiography,drug selection,therapeutic effect and prognosis.Results All patients had symptoms of cardiomegalia accompanied with heart failure on admission.Eleven cases had heart function Ⅱ,17 cases had heart function Ⅲ and 8 cases had heart function Ⅳ.The common symptoms included edema[16 cases(44.4%)],anhelation[15 cases(41.6%)] and anorexia[15 cases(41.6%)];Initial symptoms manifested as palpitations in 7 cases(19.4%) and respiratory infection in 7 cases(19.4%).Apical murmur was the most common sign in 25 cases(69.4%),with liver enlargement in 23 cases(63.9%).The cardiac troponin I levels in 17 patients were measured,and cardiac troponin I in 13 patients increased.The levels of CK-MB in 17 cases were higher than normal level.Electrocardiogram with ectopic beat,ectopic rhythm and atrioventricular block was common;Echocardiography showed that all children′s left ventricular end diastolic were expanded in varying degrees(100.0%),and 31 cases(86.1%) with the left ventricular ejection fraction50%.Left ventricular mural thrombus was found in 1 case and pulmonary hypertension in 7 cases.All children were treated by using diuretic,angiotensin-converting enzyme inhibitor and cardiotonics.Seventeen children with tachycardia and arrhythmia also took β-blocker,while 4 cases with atrial tachycardia and atrial fibrillation took amiodarone.Sixteen patients used IVIG,and 4 cases of them,who had severe complications,were treated with combined hormone therapy.The clinical symptoms of 33 cases improved and 3 patients gave up treatment.Conclusions Pediatric DCM is common in infancy,pre-school age and school age.Most have heart failure,cardiomegaly and tachyarrhythmia in different degrees when diagnosed.Treatment combined with β-blocker and amiodarone can get a better result.
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