Elevated lv diastolic pressure and low cardiac output. best generic viagra usa Rv failure causes peripheral edema and neck vein distention. Infrequently the rv is predominantly affected in younger patients, and atrial arrhythmias and sudden death due to malignant ventricular tachyarrhythmias are typical. viagra dosage do need About 25% of all patients with dcm have atypical chest pain. Diagnosis chest x-ray ecg echocardiography testing for cause as indicated diagnosis is by history, physical examination, and exclusion of other common causes of ventricular failure (eg, systemic hypertension, primary valvular disorders, mi—see table 1: cardiomyopathies: diagnosis and treatment of cardiomyopathies ). viagra dosage do need Thus, chest x-ray, ecg, and echocardiography are required. If acute symptoms or chest pain is present, serum cardiac markers are measured; although typically indicative of coronary ischemia, troponin levels can be elevated in heart failure, especially if renal function is decreased. Specific causes suspected clinically are diagnosed (see elsewhere in the manual). If no specific cause is clinically apparent, serum ferritin and iron-binding capacity and thyroid-stimulating hormone levels are measured and serologic tests for toxoplasma, t. viagra online without prescription Cruzi, coxsackievirus, and echovirus may be done in appropriate cases. Chest x-ray shows cardiomegaly, usually of all chambers. Pleural effusion, particularly on the right, often accompanies increased pulmonary venous pressure and interstitial edema. The ecg may show sinus tachycardia and nonspecific st-segment depression with low voltage or inverted t waves. Sometimes pathologic q waves are present in the precordial leads, simulating previous mi. cheap viagra on line Left bundle branch block is common. meaning bathtubs viagra ads Echocardiography shows dilated, hypokinetic cardiac chambers and rules out primary valvular disorders. viagra in women side effects Segmental wall motion abnormalities, typical of mi, can also occur in dcm because the process may be patchy. Echocardiography may also show a mural thrombus. cheapest 20 mg viagra Mri is not routinely done but may be useful when detailed imaging of myocardial structure or function is needed. viagra cost In cardiomyopathy, mri may show abnormal myocardial tissue texture. buy viagra without prescription Coronary angiography is required when the diagnosis is in doubt after noninvasive tests, particularly for patients with chest pain or several cardiovascular risk factors or for elderly patients, who are more likely to have cad. However, nonobstructive coronary artery lesions detected by angiography may not be the cause of dcm. viagra goes generic in march Either ventricle can be biopsied during catheterization, but biopsy is not usually done because the yield can be low, the disease process can be patchy, and results may not change treatment. Prognosis prognosis generally is poor, although prognosis has improved with current management regimens (eg, us. buy generic viagra online