Cardiomyopathy with cardiomegaly: a diagnostic dilemma.

The clinical angiographic, and available autopsy data of 32 patients with cardiomyopathy with cardiomegaly were reviewed. Twenty-six patients had alcoholic cardiomyopathy. Of these, 20 patients had patient coronary arteries, and 6 had significant occlusive coronary artery disease. Six patients denied any history of excessive alcohol intake, had significant occlusive coronary artery disease, and were grouped as ischemic cardiomyopathic. A total of 12 patients (37.5%) had significant occlusive coronary artery disease. The clinical separation of patients with cardiomegaly due to alcoholic cardiomyopathy from those with occlusive coronary artery disease is extremely difficult. Clinical parameters, including history of chest pain and presence of absence of abnormal Q waves on electrocardiograms, are of little value in individual cases. It seems likely that many patients with ischemic cardiomyopathy may present clinically and electrocardiographically as patients with silent occlusive coronary artery disease. This study underlines the importance of coronary angiography in making a precise diagnosis. The mortality rate during the 5-year follow-up period was 56%. The patients with alcoholic cardiomyopathy with occlusive coronary artery disease carried the worst prognosis. The outlook for patients with cardiomyopathy and cardiomegaly becomes grave once they develop left ventricular end diastolic pressure over 24 mm Hg.