Cardiologists Footnote 1
-
Current guidelines recognise the need for early involvement of cardiologists in DMD, as heart muscle declines alongside skeletal muscle
-
Close monitoring is required, as reduced exercise tolerance is hard to measure, especially in non-ambulatory patients
The cardiologist should monitor heart health throughout the disease course
At diagnosis
For the patient
Baseline evaluation
- Consultation with cardiologist
- Cardiac medical history
- Family history
- Physical examination
- ECG
- Non-invasive imaging:
- Echocardiogram (<6–7 years old)
- Cardiovascular MRI (≥6–7 years old)
For female carriers
Cardiac assessment in early adulthood
- Cardiovascular MRI
- If symptomatic or imaging-positive, increase assessment frequency per cardiologist recommendation
- If negative, repeat every 3–5 years
Periodic assessments
Annual cardiovascular assessment
- Cardiac medical history
- Physical examination
- ECG
- Non-invasive imaging
Symptomatic
- Increase assessment frequency
- Initiate pharmacological treatment
Ambulatory and early non-ambulatory
- Cardiac assessment at least annually
- Initiate ACE inhibitors or angiotensin receptor blockers by age 10
Late non-ambulatory stage
- Monitor closely for signs of cardiac dysfunction, heart failure can be difficult to diagnose
- Monitor for rhythm abnormalities
- Treat with known heart failure therapies
Surgery
- Assess with ECG and non-invasive imaging before major surgery
- Make anaesthetist aware of DMD diagnosis as patients have increased anaesthesia risk