Heart failure is rare in individuals younger than age 20. If congenital heart disease is excluded, the most common cause of heart failure in the young is idiopathic dilated cardiomyopathy (DCM). More than 50 known specific diseases of heart muscle can produce the signs, symptoms, and manifestations of idiopathic DCM. Some of these diseases include the following:
1. Infectious: Coxsackie, cytomegalovirus, HIV, Chagas disease, tuberculosis, acute rheumatic fever, toxoplas-mosis, trichinosis, echinococcus, schistosomiasis, and Lyme disease
2. Endocrine: Thyroid diseases (thyrotoxicosis and, hypothyroidism), diabetes, and acromegaly
3. Infiltrative diseases: Amyloidosis, hemochromatosis, and sarcoidosis
4. Alcoholic cardiomyopathy
5. Collagen vascular disease: Lupus erythematosus, scler-oderma, mixed connective tissue disease, polyarteritis nodosa, and rheumatoid arthritis
6. Toxic: Cocaine, heroin, amphetamines, cancer chemo-therapeutic agents, arsenic, cobalt, lead, phosphorus, and ethylene glycol
7. Nutritional: Thiamine, protein, and selenium
8. Others: Endomyocardial fibroelastosis, peripartum, and sleep apnea
Idiopathic DCM is transmitted in an autosomal dominant manner although X-linked, autosomal recessive, and mitochondrial inheritance also have been observed.

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