Dilated Cardiomyopathy

1 What is Dilated Cardiomyopathy?

Dilated cardiomyopathy refers to a progressive disease of the heart muscle in which heart muscles become enlarged, dilated and weakened.

In some people, no symptoms may be seen whereas in some people it may be fatal.

DCM can result in heart failure, arrhythmias (irregular heartbeat), blood clot or even death.

It can affect people of any age, but men aged between 20 and 60 are at a greater risk. 

2 Symptoms

Signs and symptoms of dilated cardiomyopathy (DCM) are:

  • Extreme tiredness
  • Difficulty breathing (dyspnea) upon exertion or while lying down
  • Decreased exercise capacity
  • Swelling of your legs, ankles and feet (edema)
  • Fluid accumulation in your abdomen (ascites)

When to see a doctor?

Seek immediate medical attention if you experience breathlessness or severe chest pain for more than few minutes.

If you've difficulty breathing or any of the mentioned symptoms, make an appointment with your doctor.

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3 Causes

Several factors can cause dilated cardiomyopathy, which include:

  • Hereditary factors
  • Structural heart defects you are born with (congenital)
  • Bacterial, viral, fungal and parasitic infections
  • Abuse of drug and alcohol
  • Some anti-cancer medications
  • Getting exposed to toxins, such as lead, mercury and cobalt
  • Coronary artery disease or heart attack
  • High blood pressure (hypertension)
  • Diabetes
  • Pregnancy associated complications

4 Making a Diagnosis

During the diagnosis of dilated cardiomyopathy, your doctor listens to your heart and lungs using a stethoscope. He/she can also ask you about your medical history as well as your family's medical history.

If you have dilated cardiomyopathy, your general practitioner may refer you to a cardiologist (a doctor who treats heart disease).

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful. List out all the symptoms.

Write down your key medical information. Write down the names of all your medications, vitamins or supplements. Ask a friend or a family member to accompany you during the visit.

Make a list of the questions to ask your doctor

Some typical questions can be:

  • What is the most probable cause of my symptoms?
  • What are the tests needed?
  • What are my treatment options and side effects of each option?
  • Do I need to change my diet?
  • What level of physical activity is appropriate for me?
  • How often do I need screening tests?
  • Is screening necessary for my family members too?
  • What restrictions do I need to follow?
  • Should I see a specialist?

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor.

Your doctor might ask you typical questions like:

  • When did your symptoms start appearing and how severe are they?
  • Do your symptoms occur continuously or they come and go?
  • Are your symptoms improved or worsened by certain factors?
  • Do you have a family history of dilated cardiomyopathy or other heart diseases?

Some tests that might be recommended for the diagnosis include:

Blood tests

Blood tests reveal the condition of your heart as well as detect infection, toxins or metabolic disorder in your blood that contribute to dilated cardiomyopathy.

Chest X-ray

A chest X-ray can show up abnormalities in the structure and size of the heart or fluid accumulation in and around the lungs.

Electrocardiogram (ECG)

An electrocardiogram records electrical signals of the heart. Unusual ECG patterns may be indicative of dilated cardiomyopathy.

Echocardiogram

It uses sound waves to create images of heart. The images can be used to detect if there is any abnormality in the heart.

Exercise stress test

An exercise test is used to evaluate your heart rate and oxygen use. It can reveal the severity of your condition.

CT or MRI scan

Imaging tests create a detailed picture of your heart which can be used to examine the structure and function of your heart.

Cardiac catheterization

In this procedure, a catheter is inserted into a blood vessel in your arm, groin or neck and moved up to the heart. It can be used to measure the pressure in your heart or obtain a sample of muscle tissue to detect any damage which may suggest dilated cardiomyopathy.

This procedure can also be used to examine coronary arteries by injecting a dye into your coronary arteries (coronary angiography).

Genetic screening or counseling

Genetic screening of your family members can determine if your disease is inherited. This test is recommended if no any cause of dilated cardiomyopathy is found.

5 Treatment

Treatment for dilated cardiomyopathy focuses on treating the underlying cause, if known, and improve blood flow as well as prevent progression of the disease.

Medications

A single drug or a combination of drugs may be prescribed by your doctor. Drugs used in dilated cardiomyopathy are:

Angiotensin-converting enzyme (ACE) inhibitors

ACE inhibitors are vasodilators (that widens blood vessels) and hence decrease blood pressure and heart's burden, as well as improve the blood flow. Side effects are hypotension (low blood pressure), low count of white blood cell, and kidney or liver problems.

Angiotensin II receptor blockers (ARB)

The effects are similar to those of ACE inhibitors and are opted in people who are unable to take ACE inhibitors. Side effects are diarrhea, muscle cramps and dizziness.

Beta blockers

A beta blocker lowers your heart rate and blood pressure as well as prevents harmful effects of stress hormones. It also prevents harmful effects of substance produced by your body which can aggravate heart failure and cause arrhythmias (abnormal heart rhythms).They often cause dizziness and low blood pressure.

Diuretics (water pills)

They remove excess fluid and salt from your body via urine. Consequently, there is decreased fluid in your lungs that helps you breathe easily. 

Digoxin

Digoxin or digitalis increases force of heart muscle contractions and lowers the heartbeat. Digoxin may alleviate heart failure symptoms and improve your ability to do physical exercise.

Blood-thinning medications

Your doctor may recommend drugs, such as aspirin or warfarin, to prevent the formation of blood clots. They are likely to cause excessive bleeding.

Devices

Implantable devices used in dilated cardiomyopathy are:

  • Biventricular pacemakers, used to maintain a normal heartbeat.
  • Implantable cardioverter-defibrillators (ICDs) detect life-threatening arrhythmias and send electrical shocks to control abnormal, rapid heartbeats.
  • Heart pumps (left ventricular assist devices or LVADs): They facilitate pumping action of your heart.
  • Heart transplant: Heart transplant is opted if other treatment approaches become unsuccessful.

6 Prevention

Following tips can prevent the effects of dilated cardiomyopathy:

  • Don’t smoke. If you don’t, don’t start.
  • Limit or avoid alcohol.
  • Don't use cocaine or other illegal drugs.
  • Always eat a healthy diet.
  • Maintain a healthy weight.
  • Exercise regularly. Follow an exercise schedule as suggested by your doctor.
  • Get adequate sleep. Take rest.

7 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with dilated cardiomyopathy.

Following measures might be useful if you have dilated cardiomyopathy:

  • Exercise: Discuss with your doctor about the safe physical activities and exercises for you. Competitive sports can add strain to your failing heart and may cause sudden death.
  • Don't smoke. Your doctor can suggest you some smoking cessation methods.
  • Avoid illegal drugs and drink in moderation. Cocaine or other illegal drugs increase your heart’s load.
  • Try to maintain a healthy weight. Extra weight adds extra pressure to your heart.
  • Eat a healthy diet. Eat diets that contain whole grains, and a variety of fruits and vegetables. Cut down on salt, sugar, cholesterol, saturated and trans-fat intake.

8 Risks and Complications

There are several risks and complications associated with dilated cardiomyopathy.

Risks

Dilated cardiomyopathy is most common in men of ages 20 to 60 years.

  • High blood pressure (hypertension)
  • Diseases of blood vessels in your heart (Coronary artery disease)
  • Damaged heart muscle due to heart attack
  • Family history
  • Excessive alcohol consumption
  • Certain anti-cancer medications and radiation treatment for cancer
  • Use of cocaine
  • Infections of the heart muscle by bacteria or virus
  • Disease related to metabolism, such as thyroid disease or diabetes
  • Diseases that cause heart muscle damage such as, including hemochromatosis and sarcoidosis
  • Obesity
  • Deficiencies of essential vitamins and minerals, such as selenium
  • Inflammation of heart muscle caused by auto-immune disorders, such as lupus
  • Exposure to metals and other toxic compounds, such as lead, mercury and arsenic
  • Disorders of nerve and muscles, such as muscular dystrophy
  • HIV infection

Complications

Heart failure

Decreased blood flow from the left ventricle can cause heart failure.

Heart valve regurgitation

Enlarged left ventricle interrupts the normal functioning of heart valves which cause blood to flow backward. It makes your heart difficult to pump the blood.

Fluid buildup (edema)

Accumulation of fluid in the lungs, abdomen, legs and feet causes edema.

Irregular heartbeats (arrhythmia)

Arrhythmias develop due to abnormal structure of heart and changes in pressure of the heart's chambers.

Sudden cardiac arrest

Dilated cardiomyopathy can suddenly cease heart functions.

Blood clots (emboli)

Collection of blood (stasis) in the left ventricle can form blood clots. These clots can enter bloodstream and restrict blood supply to vital organs which leads to stroke or heart attack.

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