Cardiomyopathy — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 57 of 2024

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting cardiomyopathy or death from cardiomyopathy with the circumstances of a person's relevant service:

1. (1)
   undergoing a course of radiotherapy for cancer, where the heart was in the field of radiation, before the clinical onset or clinical worsening;
2. (2)
   having myocarditis before clinical onset or at the time of clinical worsening;
3. (3)
   having infection with Trypanosoma cruzi (Chagas disease) before clinical onset or clinical worsening;
4. (4)
   having infection with human immunodeficiency virus before clinical onset or clinical worsening;
5. (5)
   having phaeochromocytoma or paraganglioma at the time of clinical onset or clinical worsening;

   Note: paraganglioma and phaeochromocytoma are defined in the Schedule 1 - Dictionary.

6. (6)
   having infiltration of the myocardium due to: (a) amyloidosis; (b) iron overload (haemosiderosis); or (c) sarcoidosis; at the time of the clinical onset or clinical worsening;

   Note: iron overload is defined in the Schedule 1 - Dictionary.

7. (7)
   having a primary or metastatic neoplasm infiltrating the myocardium at the time of the clinical onset or clinical worsening;
8. (8)
   having one of the following endocrine disorders: (a) acromegaly; (b) adrenal insufficiency; (c) Cushing syndrome; (d) diabetes mellitus; (e) hyperthyroidism, including goitre or Graves disease that has resulted in hyperthyroidism; (f) hypoparathyroidism; (g) hypothyroidism, including Hashimoto thyroiditis that has resulted in hypothyroidism; (h) primary hyperaldosteronism; or (i) thyrotoxicosis; at the time of clinical onset or clinical worsening;

   Note: acromegaly and primary hyperaldosteronism are defined in the Schedule 1 - Dictionary.

9. (9)
   being obese at the time of clinical onset or clinical worsening;

   Note: being obese is defined in the Schedule 1 - Dictionary.

10. (10)
    having a clinically apparent nutritional deficiency involving: (a) carnitine; (b) niacin (pellagra); (c) selenium (Keshan disease); or (d) thiamine (wet beriberi); at the time of clinical onset or clinical worsening;
11. (11)
    having coeliac disease at the time of clinical onset or clinical worsening;
12. (12)
    having acquired generalised lipodystrophy at the time of the clinical onset or clinical worsening;

    Note: lipodystrophy is defined in the Schedule 1 - Dictionary.

13. (13)
    having chronic renal failure at the time of clinical onset or clinical worsening as indicated by any of the following: (a) a glomerular filtration rate of less than 15 mL/min/1.73 m2 for a period of at least 3 months; or (b) undergoing chronic dialysis for renal failure;
14. (14)
    having cirrhosis of the liver before clinical onset or clinical worsening;
15. (15)
    taking one of the following medications within the 3 months before clinical onset or clinical worsening: (a) 5-fluorouracil (non-topical); (b) alemtuzumab; (c) amphotericin B; (d) anagrelide; (e) bevacizumab; (f) cisplatin; (g) clozapine; (h) cobimetinib; (i) cyclophosphamide; (j) dasatinib; (k) exogenous catecholamine; (l) ifosfamide; (m) imatinib; (n) interferon alpha; (o) isotretinoin or tretinoin; (p) lithium; (q) methylphenidate; (r) mitomycin C; (s) olanzapine; (t) osimertinib; (u) paclitaxel (when used in combination with doxorubicin); (v) sunitinib; (w) tacrolimus; (x) trabectedin; (y) trametinib; (z) trastuzumab; or (aa) zidovudine;
16. (16)
    taking a medication that cannot be ceased or substituted in the long term and which is associated in the individual with the development/worsening of cardiomyopathy during medication therapy; and either: (a) the improvement of cardiomyopathy within days or weeks of discontinuing or tapering medication therapy; or (b) the redevelopment/worsening of cardiomyopathy on rechallenge with the same medication; and where the medication was being taken within the 3 months before clinical onset or clinical worsening;
17. (17)
    being treated with an anthracycline within the 25 years before clinical onset or clinical worsening;

    Note: anthracycline is defined in the Schedule 1 - Dictionary.

18. (18)
    taking chloroquine or hydroxychloroquine daily for at least the one year before clinical onset or clinical worsening;
19. (19)
    for males only, consuming an average of at least 80 grams of alcohol per day for a continuous period of at least 5 years, before clinical onset or clinical worsening;

    Note: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.

20. (20)
    for females only, consuming an average of at least 40 grams of alcohol per day for a continuous period of at least 5 years, before clinical onset or clinical worsening;

    Note: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.

21. (21)
    using one of the following illicit drugs at the time of clinical onset or clinical worsening: (a) amphetamines or amphetamine derivatives, including 3, 4- methylenedioxymethamphetamine (Ecstasy); (b) anabolic-androgenic steroids; or (c) cocaine;
22. (22)
    being poisoned with cobalt, as demonstrated by haematological or biochemical evidence, at the time of clinical onset or clinical worsening;
23. (23)
    being in the last trimester of pregnancy or being within the six months immediately postpartum at the time of clinical onset or clinical worsening;
24. (24)
    undertaking intense physical activity of at least 6 METs at the time of clinical worsening;

    Note: MET is defined in the Schedule 1 - Dictionary.

25. (25)
    being a prisoner of war of Japan before clinical onset;
26. (26)
    experiencing a severe stressful event that causes an intense emotional or psychological response within the 30 days before the clinical onset or clinical worsening of takotsubo cardiomyopathy;

    Note: takotsubo cardiomyopathy is defined in the Schedule 1 - Dictionary.

27. (27)
    having: (a) an injury or illness requiring admission to an intensive care unit or artificial ventilation; (b) major trauma; or (c) septicaemia; within the 30 days before the clinical onset or clinical worsening of takotsubo cardiomyopathy;

    Note: artificial ventilation is defined in the Schedule 1 - Dictionary.

    Note: takotsubo cardiomyopathy is defined in the Schedule 1 - Dictionary.

28. (28)
    having a cerebrovascular accident (stroke) or subarachnoid haemorrhage within the 30 days before the clinical onset or clinical worsening of takotsubo cardiomyopathy;

    Note: takotsubo cardiomyopathy is defined in the Schedule 1 - Dictionary.

29. (29)
    being envenomated by a: (a) bee or wasp; (b) jellyfish such as the box jellyfish or Pelagia noctiluca (mauve stinger); (c) scorpion; (d) snake; or (e) spider such as a funnel web spider, red back or katipō (black widow) spider; within the 24 hours before the clinical onset or clinical worsening of takotsubo cardiomyopathy;

    Note: takotsubo cardiomyopathy is defined in the Schedule 1 - Dictionary.

30. (30)
    having hypertension for at least the 5 years before the clinical onset of hypertensive cardiomyopathy, or at the time of the clinical worsening of hypertensive cardiomyopathy;
31. (31)
    inability to obtain appropriate clinical management for cardiomyopathy before clinical worsening;