Dilated cardiomyopathy or DCM is a condition in which the heart becomes weakened and enlarged and cannot pump blood efficiently. The decreased heart function can affect the lungs, liver, and other body systems. DCM is one of the cardiomyopathies, a group of diseases that affect primarily the myocardium (the muscle of the heart). Different cardiomyopathies have different causes and affect the heart in different ways. In DCM a portion of the myocardium is dilated, often without any obvious cause. Left or right ventricular systolic pump function of the heart is impaired, leading to progressive cardiac enlargement and hypertrophy, a process called remodelingEtiology
Dilated cardiomyopathy most commonly occurs in men, ages 20 to 60. Other risk factors include:
1. High blood pressure (hypertension)2. Coronary artery disease
3. Damage to the heart muscle from a heart attack
4. Family history of dilated cardiomyopathy
5. Alcoholism
6. Certain chemotherapy drugs and radiation for treating cancer
7. Cocaine use
8. Viral or bacterial infections of the heart muscle
9. Metabolic disorders, such as thyroid disease or diabetes
10. Diseases that can damage the heart, including hemochromatosis and sarcoidosis
11. Obesity
12. Nutritional deficiencies of essential vitamins and minerals, such as selenium
13. Inflammation of heart muscle from immune system disorders, such as lupus
14. Metals and other toxic compounds, such as lead, mercury and arsenic
15. Neuromuscular disorders, such as muscular dystrophy
16. HIV infection
Cause of DCM
a) Genetics
b) Congenital heart defects
c) Infections, including those caused by bacteria, viruses, fungi and parasites
d) Drug and alcohol abuse
e) Certain cancer medications
f) Exposure to toxins, such as lead, mercury and cobalt
g) Coronary artery disease or heart attack
h) High blood pressure (hypertension)
i) Diabetes
j) Complications of late-stage pregnancy
Clinical presentation
If you have dilated cardiomyopathy, you're likely to have signs and symptoms of heart failure or arrhythmias caused by your condition. Signs and symptoms include:1. Fatigue
2. Shortness of breath (dyspnea) when you're active or lying down
3. Reduced ability to exercise
4. Swelling (edema) in your legs, ankles and feet
5. Swelling of your abdomen (ascites)
6. Enlarged heart, with pulmonary edema and an elevated jugular venous pressure
7. Low pulse pressure
8. Signs of mitral and tricuspid regurgitation
9. Tachycardia
Diagnosis
✔ Blood tests
✔ Chest X-ray.
✔ Electrocardiogram (ECG).
✔ Exercise stress test.
✔ CT or MRI scan.
✔ Cardiac catheterization.
✔ Genetic screening or counseling.
Treatments
Management and treatment of dilated cardiomyopathy has improved significantly in the last decade. Drug therapy can slow down progression and in some cases even improve the heart condition. Standard therapy may include salt restriction, Alcohol should be avoided. Group of medicine used for treating DCM
✎ Angiotensin-converting enzyme (ACE) inhibitors: ACE inhibitors are a type of drug that widens or dilates blood vessels (vasodilator) to lower blood pressure, improve blood flow and decrease the heart's workload. ACE inhibitors may improve heart function.
Side effects include low blood pressure, low white blood cell count, and kidney or liver problems.
✎ Angiotensin II receptor blockers: These drugs have many of the beneficial effects of ACE inhibitors and may be an alternative for people who can't tolerate ACE inhibitors. Side effects include diarrhea, muscle cramps and dizziness.
✎ Beta blockers: A beta blocker slows your heart rate, reduces blood pressure and prevents some of the harmful effects of stress hormones, substances produced by your body that can worsen heart failure and trigger abnormal heart rhythms.
Beta blockers may reduce signs and symptoms of heart failure and improve heart function. Side effects include dizziness and low blood pressure.
✎Diuretics: Often called water pills, diuretics remove excess fluid and salt from your body. The drugs also decrease fluid in your lungs, so you can breathe more easily.
Digoxin: This drug, also known as digitalis, strengthens your heart muscle contractions. It also tends to slow the heartbeat. Digoxin may reduce heart failure symptoms and improve your ability to be active.
✎ Blood-thinning medications: Your doctor may prescribe drugs, including aspirin or warfarin (Coumadin), to help prevent blood clots. Side effects include excessive bruising or bleeding.
There is some evidence for the benefits of Coenzyme Q10 in treating heart failure. Other supplements provided may include L-Carnitine, Taurine and D-Ribose.
Devices
Implantable devices used to treat dilated cardiomyopathy include:
❤ Biventricular pacemakers: which use electrical impulses to coordinate the actions of the left and right ventricle.
❤ Implantable cardioverter-defibrillators (ICDs): which monitor heart rhythm and deliver electrical shocks when needed to control abnormal, rapid heartbeats, including those that cause the heart to stop. They can also function as pacemakers.
❤ Heart pumps (left ventricular assist devices, or LVADs): These mechanical devices are implanted into the abdomen or chest and attached to a weakened heart to help it pump. They usually are considered after less invasive approaches are unsuccessful.
Heart transplant: if medications and other treatments are no longer effective.
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