Dilated cardiomyopathy

Description

Dilated cardiomyopathy is a type of disease of the heart muscle that causes the heart chambers (the ventricles) to lose weight and stretch, getting bigger and bigger. It usually starts in the heart's main pumping chamber (left ventricle). Dilated cardiomyopathy makes it harder for the heart to pump blood to the rest of the body.

Symptoms of dilated cardiomyopathy — such as fatigue and shortness of breath — can be similar to other health conditions. A person with dilated cardiomyopathy may not notice any symptoms at first. But the dilated cardiomyopathy can be life-threatening. It is a common cause of heart failure.

Dilated cardiomyopathy is more common in men than in women. The treatment of dilated cardiomyopathy can include medications or surgery for the implantation of a medical device that controls the beating of the heart or helps the heart to pump blood. Sometimes, a heart transplant is needed.

Symptoms

Some people with dilated cardiomyopathy has no signs or symptoms in the early stages of the disease.

The signs and symptoms of dilated cardiomyopathy can include:

  • Fatigue
  • Shortness of breath (dyspnea) during activity or while lying down
  • Decreased ability to exercise
  • Swelling (edema) in the legs, ankles, feet, or the belly (abdomen)
  • Chest pain or discomfort
  • Rapid, fluttering or pounding heartbeat (palpitations)

When to see a doctor

If you're short of breath or have other symptoms of dilated cardiomyopathy, consult your health care provider as soon as possible. Call 911 or the local emergency number if you have pain in the chest that lasts more than a few minutes or have severe difficulty breathing.

If a family member has cardiomyopathy, dilated, talk with your health care provider. Some types of dilated cardiomyopathy in families (inherited). Genetic testing may be recommended.

Causes

It can be difficult to determine the cause of the dilated cardiomyopathy. However, many things can cause the left ventricle to dilate and weaken, including:

  • Certain infections
  • The complications of the last stage of pregnancy
  • Diabetes
  • Excess iron in the heart and other organs (hemochromatosis)
  • Heart rhythm problems (arrhythmias)
  • High blood pressure (hypertension)
  • Obesity
  • Heart valve disease, such as mitral valve or aortic valve regurgitation

Other possible causes of dilated cardiomyopathy include:

  • The misuse of Alcohol
  • Exposure to toxins, such as lead, mercury, and cobalt
  • Use of certain medications for cancer
  • Use of illegal drugs, such as cocaine or amphetamines.

Risk factors

Risk factors for dilated cardiomyopathy include:

  • The damage to the heart muscle from certain diseases, such as hemochromatosis
  • The family history of dilated cardiomyopathy, heart failure, or sudden cardiac arrest
  • Heart valve disease
  • Inflammation of the heart muscle disorders of the immune system, such as lupus
  • Long-term excessive alcohol, or use illegal drugs
  • Long-term high blood pressure
  • Neuromuscular disorders such as muscular dystrophy

Complications

The complications of dilated cardiomyopathy include:

  • Heart failure. The heart can't pump enough blood to meet the body's needs. Without treatment, heart failure can be life-threatening.
  • Leakage of the valves of the heart (heart valve regurgitation). Cardiomyopathy may make it more difficult for the heart, the valves close. Blood may leak backward through a valve in the heart.
  • Irregular heartbeats (arrhythmias). Changes in the heart's size and shape can interfere with the heart's rhythm.
  • The sudden cardiac arrest. Dilated cardiomyopathy can cause the heart to suddenly stop beating.
  • The blood clots. Accumulation of blood in the left lower chamber of the heart can lead to the formation of blood clots. If clots enter the bloodstream, they can block blood flow to other organs, including the heart and the brain. Blood clots can cause a stroke, heart attack or damage to other organs. Arrhythmias can also cause blood clots.

Prevention

Healthy lifestyle habits can help prevent or reduce the complications of dilated cardiomyopathy. Try these heart-smart strategies:

  • Avoid or limit consumption of alcohol.
  • Do not smoke.
  • Do not use cocaine or other illegal drugs.
  • Eating a healthy diet that is low in salt (sodium).
  • Get enough rest and sleep.
  • Get regular exercise.
  • Maintain a healthy weight.
  • Manage stress.

Dilated cardiomyopathy

Diagnosis

To diagnose dilated cardiomyopathy, your health care provider will perform a physical exam and ask questions about your personal and family medical history. The doctor will use a device called a stethoscope to listen to the heart and lungs. You may be referred to a doctor who specializes in diseases of the heart (cardiologist).

Tests

Tests to diagnose dilated cardiomyopathy include:

  • The echocardiogram. This is the main test for the diagnosis of dilated cardiomyopathy. The sound waves produce images of the heart in motion. An echocardiogram shows how blood moves in and out of the heart and heart valves. Can you tell if the left ventricle is enlarged.
  • Blood tests. Various blood tests may be done to detect possible infections, substances or diseases such as diabetes or hemochromatosis — which can lead to dilated cardiomyopathy.
  • X-ray of the chest. A chest x-ray shows the shape and condition of the heart and the lungs. You can reveal fluid in or around the lungs.
  • Electrocardiogram (ECG or EKG). This quick and easy test records the electrical activity of the heart. An electrocardiogram (ECG) may show the rapidity or slowness with which the heart is beating. The patterns in the signals that can help to diagnose the heart rate of the disease or the reduced blood flow.
  • Holter Monitor. This portable device can be used for a day or more, to record the heart's activity during daily activities.
  • Exercise stress test. This test often consists of walking on a treadmill or riding a stationary bike while the heart is controlled . Exercise tests can help reveal how the heart responds to physical activity. If you can't do the exercise, you may be given drugs that mimic the effect of exercise on the heart.
  • Heart (cardiac) computed tomography or magnetic resonance imaging. These imaging tests can show the size and function of the pumping chambers of the heart. A cardiac ct scan uses a series of X-rays to create detailed pictures of the heart. A cardiac mri uses magnetic fields and radio waves.
  • The cardiac catheterization. During this procedure, one or more long and thin tubes (catheters) are inserted into a blood vessel, usually in the groin and guided up to the heart. Contrast dye flows through the catheter to help the arteries of the heart show up more clearly on x-ray images. During cardiac catheterization, a sample of tissue (biopsy) may be taken to check the damage to the heart muscle.
  • Genetic research or advice. Cardiomyopathy can be transmitted from parents to children (inherited). Ask your health care provider if genetic testing is right for you. The family screening or genetic testing may include first-degree relatives (parents, siblings and children.

Treatment

The treatment of dilated cardiomyopathy depends on the cause. The goals of treatment are to reduce symptoms, improve blood flow and prevent further damage to the heart. Dilated cardiomyopathy treatment may include medication or surgery for the implantation of a medical device that helps the heart to beat or to pump blood.

Drugs

A combination of medications may be used for the treatment of dilated cardiomyopathy and prevent complications. The medication is used for:

  • Control the rhythm of the heart
  • Help the heart pump better
  • Lower blood pressure
  • Prevent blood clots
  • Reduce fluid retention in the body

The drugs used to treat heart failure and dilated cardiomyopathy include:

  • Blood pressure medications. Different types of medications can be used to lower blood pressure, improve blood flow and reduce the pressure on the heart. Such drugs include beta-blockers, inhibitors of the angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin II receptor blockers (arbs).
  • Sacubitril/valsartan (Entresto). This medicine combines an angiotensin two receptor blocker (ARB) with another type of medication to help the heart better to pump blood to the rest of the body. It is used to treat people with chronic heart failure.
  • Water pills (diuretics). A diuretic that removes excess fluid and salt from the body. Too much fluid in the body of the strains of the heart and can make it hard to breathe.
  • Digoxin (Lanoxin). This medicine can strengthen the heart muscle contractions. It also tends to slow the heart rate. Digoxin can reduce the symptoms of heart failure and to make it easier to be active.
  • Ivabradine (Corlanor). In rare cases, this medicine may be used to control heart failure caused by dilated cardiomyopathy.
  • Blood thinners (anticoagulants). These drugs help prevent blood clots.

Surgeries or other procedures

Surgery may be needed for the implantation of a device to control the rhythm of the heart, or helping the heart to pump blood. The type of devices that are used for the treatment of dilated cardiomyopathy include:

  • Biventricular Pacemaker. This device is for people who have heart failure and irregular heartbeats. A biventricular pacemaker stimulates both the heart's lower chambers (the right and left ventricles) to make your heart beat better.
  • Implantable cardioverter-defibrillators (ICD). An implantable cardioverter defibrillator (ICD) will not treat cardiomyopathy itself. Monitors the heart rhythm and delivers an electric shock if an irregular heartbeat (arrhythmia) is detected. Cardiomyopathy can cause dangerous arrhythmias, including those that cause the heart to stop.
  • Left ventricular assist devices (LVAD). This mechanical device that helps a weakened heart pump better. A left ventricular assist device (LVAD) is usually considered after less invasive approaches are incorrect. Can be used as a long-term treatment or as a short-term treatment while waiting for a heart transplant.

If medications and other treatments for dilated cardiomyopathy does not work, a heart transplant may be necessary.

Self-care

If you have dilated cardiomyopathy, these self-care strategies that can help you manage your symptoms:

  • Eating a heart-healthy diet. Choose whole grains, and a variety of fruits and vegetables. Limit salt, added sugar, cholesterol, and saturated and trans fats. Ask your care provider for a referral to a dietitian if you need help planning your diet.
  • Exercise. Talk with your doctor about what activities could be safe and beneficial for you. In general, competitive sports, are not recommended because they may increase the risk of heart attack and causing sudden death.
  • Maintain a healthy weight. Excess weight makes your heart work harder.
  • Stop smoking. If you need help, a service provider can recommend or prescribe strategies to help you stop smoking.
  • Avoid or limit consumption of alcohol. Talk with your health care provider about the use of alcohol and if it is safe for you.
  • Do not use illegal drugs. The use of cocaine or other stimulant drugs can cause stress on the heart.

Preparing for your appointment

If you think you may have dilated cardiomyopathy or you are concerned about your risk due to family history, to make an appointment with your health care provider. Your doctor may refer you to a doctor who specializes in heart conditions (cardiologist).

Here is the information to help you prepare for your appointment.

What you can do

  • Be aware of any pre-appointment restrictions. When you make the appointment, ask if there is something that you need to do in advance, such as restrict your diet.
  • Write down your symptoms, including any that may seem unrelated to dilated cardiomyopathy, and when they began.
  • Write down key personal information, including major stresses or recent life changes, and a family history of heart disease, stroke, high blood pressure or diabetes.
  • List of all the medicines, vitamins, and supplements you are taking, including dosage.
  • Have a family member or friend along, if possible. Someone who accompanies you may remember something that you missed or forgot.
  • Be prepared to discuss your diet and exercise habits. If you do not already follow a diet or exercise routine, talk with your provider about how to get started.
  • Write questions to ask their provider.

For dilated cardiomyopathy, some basic questions include:

  • What is likely causing my symptoms or condition?
  • What are other possible causes?
  • What tests are needed?
  • What is the best treatment?
  • What are the alternatives to the primary approach you're suggesting?
  • Is there a generic alternative to the medicine you're prescribing?
  • How should I change my diet?
  • What is an appropriate level of physical activity?
  • My family must be filtered for dilated cardiomyopathy?
  • I have other health conditions. How can I best manage them together?
  • Are there brochures or other printed material I can have? What sites do you recommend?

What to expect from your doctor

Your provider is likely to ask several questions, including:

  • Do you always have symptoms, or the symptoms come and go?
  • How severe are the symptoms?
  • What, in any case, it improves your symptoms?
  • What, in any case, it makes your symptoms worse?
  • Do any of your blood relatives have dilated cardiomyopathy or other types of heart disease?
Symptoms and treatment of Dilated cardiomyopathy