Dilated Cardiomyopathy

Dilated cardiomyopathy can be inherited or caused by environmental factors, such as:

• Viral infections of the heart
• Severe coronary artery disease
• Drugs that damage the heart
• Heart valve abnormalities
• Diabetes
• Thyroid disease
• Alcoholism

Risk factors for dilated cardiomyopathy include:

• Ethnicity: African Americans are at higher risk of developing dilated cardiomyopathy
• Gender: Men are more affected than women
• Genetic predisposition: A family history of cardiomyopathy, heart failure, or sudden cardiac arrest, could increase the risk of developing the condition
• Associated cardiac problems: The risk of dilated cardiomyopathy increases if you have other disorders, such as coronary heart disease or a history of heart attack
• Excessive alcohol intake: Excessive alcohol consumption can cause left ventricular dilatation

Because dilated cardiomyopathy is a progressive condition, your body adapts to the changes and you may not notice any symptoms initially. Though your heart at rest may function normally, symptoms may appear with exertion or stress as the condition worsens.

Since dilated cardiomyopathy is a common cause of congestive heart failure, the initial symptoms of cardiomyopathy are similar to those of congestive heart failure and may include:

• Dyspnea (shortness of breath)
• Shortness of breath with exertion
• Orthopnea (shortness of breath when lying down)
• Edema (fluid retention in the feet, ankles, legs, or abdomen)
• Chest pain
• Palpitations
• Blood clots
• Lung congestion
• Fatigue
• Decreased exercise capacity
• Weight gain
• Lightheadedness
• Fainting episodes
• Sudden death

Your cardiologist will take a thorough medical history, assess your symptoms, and perform a physical exam to confirm a diagnosis of dilated cardiomyopathy. Additional tests that may be ordered include:

• Blood tests: Can determine dilated cardiomyopathy and detect the potential causes, such as an infection or a metabolic issue; recommended tests include thyroid function tests, HIV serology, electrolytes, and iron studies
• Genetic testing: May be ordered if there is a family history of cardiac diseases
• Serum B-type natriuretic peptide (BNP) levels: Done if the diagnosis is uncertain; high BNP levels are consistent with the diagnosis of dilated cardiomyopathy, and BNP levels may help determine the prognosis
• Urine toxicology: Done to check for alcohol or other substance abuse
• Chest X-ray: May reveal cardiomegaly as well as pulmonary effusions and venous congestion
• CT scan and MRI: Can detect both structural and functional abnormalities
• Electrocardiogram: May reveal nonspecific ST segment and T wave abnormalities, as well as detect atrial fibrillation 
• Echocardiography: Provides an objective assessment of ventricular size, function, and any associated valve anomalies, which is crucial to diagnosing dilated cardiomyopathy; can help providers differentiate between dilated cardiomyopathy and hypertrophic and restrictive cardiomyopathy.
• Coronary angiography: Evaluates coronary architecture and helps rule out occult ischemia diseases in people with no history of coronary artery disease
• Myocardial biopsy: May be done when storage disorders or infiltrative causes are suspected; however, a myocardial biopsy may cause unnecessary risk

Treatment for dilated cardiomyopathy focuses on managing symptoms and reducing complications. Continuous monitoring is crucial. Treatment options are customized depending on the presenting symptoms.

Medications

Medications used to treat the condition may include:

• Anti-inflammatory agents: Administered immediately after diagnosis to reduce inflammation
• Steroids: Administered to suppress immune responses that damage the heart but may not work in all cases
• Diuretics: Reduce blood volume by eliminating excess fluids from the body through urine; with the reduction of blood volume, the load on the heart reduces
• Beta-blockers: Reduce blood pressure
• Angiotensin-converting enzyme inhibitors: Improve blood circulation
• Inotropes: Digoxin improve the contractility of the cardiac muscles and improves the heart’s output

Certain medications used to treat dilated cardiomyopathy have adverse effects. Thus, proper care and precautions are to be followed while taking these medications:

• Angiotensin-converting enzyme inhibitors may result in several episodes of low blood pressure. Long overdoses of the combination medications can have adverse effects on the functioning of the kidneys and liver.
• Beta-blockers can occasionally produce dizziness and muscular cramping.
• Blood thinning drugs help the heart ventricles flow blood easily. However, accidental injury, even a minor cut on your finger, can result in significant blood loss.

Mechanical heart

If heart function worsens and medicines do not help, ventricular assist devices (mechanical cardiac support methods) may help. These devices are surgically implanted into the heart. Some implants produce pulsations like the human heart. Others do not produce pulsations but improve blood circulation.

In most cases, adults can get complete implantation of these devices. Newborns and toddlers, due to their small size, cannot have complete insertion. In some cases, the person may be put on extracorporeal membrane oxygenation (ECMO) machine, which is a heart-lung bypass machine that aids these organs. Mechanical cardiac support carries several risks, including serious infections and blood clots.

Heart transplantation

Heart transplantation is the last resort when other treatments fail or there is permanent heart damage. Though it seems to be the ultimate cure, the recipient must undergo continuous medical care and should take immunosuppressants to prevent organ rejection. Because the life of a transplanted heart is short-lived, some people may require a second heart transplant.

Dilated cardiomyopathy is a progressive condition that can lead to serious heart problems.

Cardiomyopathy caused by a virus may be cured with medications. However, cardiomyopathy caused by muscle dystrophy, cancer treatments, or metabolic disorders is usually progressive.

About 33% of people with dilated cardiomyopathy recover from the condition, 33% remain the same with impaired cardiac function, and 33% develop heart failure which may result in death. Heart transplantation is the only effective treatment to improve survival rates.

Dilated cardiomyopathy can be caused by hereditary factors, alcoholism, thyroid disorders, or even diabetes. It is critical to follow a suitable diet plan and take appropriate medications to treat the condition.

High blood pressure is often associated with dilated cardiomyopathy, so you should follow a low-sodium diet. Daily salt consumption should not exceed 2000 to 3000 mg per day. Avoid processed and fried foods, as well as foods high in concentrated salt components, such as pickles, sauce, and ketchup.