Dilated cardiomyopathy is a serious condition because it increases the chances of life-threatening conditions, such as heart failure, irregular heartbeats (arrhythmias), and blood clots. Dilated cardiomyopathy is the most common type of cardiomyopathy. In this condition, the walls of the heart become thin and the heart gets larger. As a result, the heart may not be pumping as well as it should. This can cause severe problems for the rest of the body including death. It can also make existing heart problems worse. It affects men more often than women and tends to occur in adults aged 20 to 60 years old. The common signs and symptoms of dilated cardiomyopathy are:
- Shortness of breath
- Unexplained tiredness
- Reduced ability to exercise
- Lack of energy
- Chest pain
- Fluid build-up in the lungs
- Swollen feet or ankles or unexplained weight gain
- Heart skipping beats, fluttering or thumping
- Unusual heart sounds (heart murmurs)
- Fainting, dizziness, or lightheadedness
- Swelling of the veins of the neck
- Swelling in the belly (abdomen) with less appetite
What are the causes of dilated cardiomyopathy?
The causes of dilated cardiomyopathy are unknown; however, the following are common risk factors that may cause or trigger dilated cardiomyopathy:
- Congenital (by birth or sometimes inherited through genes)
- Severe coronary artery disease, which is the most common cause
- High blood pressure
- Amphetamines and Cocaine drugs use or abuse
- History of heart attack
- Severe alcohol abuse
- Swelling of the heart's walls
- Lack of oxygen in the heart
- Heart valve disease
- Cancer and chemotherapy drugs
- Disturbances of the heart's rhythm or rate
- Autoimmune illnesses
- Infections, including those caused by bacteria, viruses, fungi, and parasites
- Exposure to toxins, such as lead, mercury, and cobalt
- Complications of late-stage pregnancy
What are the treatment options for dilated cardiomyopathy?
Treatment options for dilated cardiomyopathy are lifestyle modifications, medications, and surgery.
- It starts with minimizing alcohol intake, smoking cessation, minimizing salt in the diet, and reducing caffeine intake.
- A balanced diet with moderate exercise may help in reducing symptoms by maintaining body weight and increasing the heart functioning mechanism.
- Diuretics or water tablets may reduce the fluid build-up by encouraging the kidneys to get rid of excess water as urine.
- ACE inhibitors help in relaxing the smooth muscle around the blood, making it easier for the heart to work.
- Beta-blockers reduce the rate and force of the heart’s contraction by reducing the stimulation of adrenaline, which would normally make the heartbeat faster.
- Antiarrhythmic drugs may help in maintaining a normal rhythm.
- Blood thinners reduce the risk of blood clot formation.
- Angiotensin II Receptor Blockers (ARBs) enlarge the blood vessels, which help to reduce blood pressure, and they may be used if the person is not able to tolerate ACE inhibitors.
- Ivabradine may be used for people who are unable to take beta-blockers.
- Sacubitril and Valsartan/Entresto contain the ARB Valsartan and an antihypertensive drug called Sacubitril. It is a relatively new medication and may be used in severe heart failure when a combination of ACE inhibitors and beta-blockers are not effective.
Surgery and devices:
- Pacemakers and biventricular pacemakers help in maintaining normal rhythm. This may be recommended for people with some types of arrhythmias.
- ICDs or implantable cardioverter-defibrillators help in correcting dangerous arrhythmias that may lead to a cardiac arrest.
- An ICD combined with a biventricular pacemaker is used if both functions are required.
- The left ventricular assist device is a mechanical device that helps to pump the blood out of the left ventricle (main pumping chamber of the heart) when it is not working properly. Currently, this is only used to support the heart while waiting for a transplant.
- A heart transplant is a final choice if the heart doesn’t respond to other treatments. This involves removing the failing heart and replacing it with a donor’s heart.
What is the outlook of patients with dilated cardiomyopathy (DCM)?
Many patients with DCM can lead relatively normal lives once the diagnosis has been established and appropriate therapies have been started. The long-term outlook varies depending on the cause, severity, and degree of functional impairment. Patients need to be watched closely for the development of heart failure, abnormal heart rhythms, blood clots inside the heart, and other signs that imply the heart is not able to maintain normal blood flow. Once signs of heart failure or significantly abnormal rhythms appear, aggressive therapy is needed with close monitoring. Patients may recover and stabilize; however, life-threatening conditions including death may not be ruled out.