Rosh Emergency Medicine Practice Test

What echocardiographic feature may indicate dilated cardiomyopathy in a patient with a history of alcohol use?

1. Asymmetric left ventricular hypertrophy

2. Left ventricular enlargement and hypokinesis with diminished systolic function

3. Nondilated ventricles with decreased diastolic function

4. Thickened aortic leaflets with decreased systolic function

The correct answer is: Left ventricular enlargement and hypokinesis with diminished systolic function

The identification of left ventricular enlargement and hypokinesis with diminished systolic function serves as a hallmark echocardiographic feature of dilated cardiomyopathy (DCM), particularly in individuals with a history of alcohol use. DCM is characterized by the dilation of the heart chambers, primarily affecting the left ventricle, which results in impaired myocardial contractility. In patients with a history of chronic alcohol consumption, the myocardium can become weakened and less effective, leading to enlargement of the left ventricle and a decrease in its ability to contract properly, which manifests as hypokinesis. This left ventricular impairment is crucial for diagnosing DCM, as these changes reflect the underlying pathology of the disease—myocardial damage resulting from toxic effects of alcohol. By contrast, the other options represent features that are not typically associated with dilated cardiomyopathy. Asymmetric left ventricular hypertrophy is more characteristic of conditions such as hypertrophic cardiomyopathy or aortic stenosis. Nondilated ventricles with decreased diastolic function would suggest other cardiac issues, such as restrictive cardiomyopathy. Lastly, thickened aortic leaflets with decreased systolic function do not correspond to the dilated nature of the ventricles typically observed in D