Dilated cardiomyopathy
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Dilated cardiomyopathy is a form of heart muscle illness in which the ventricles tissue thins as it enlarges, causing it to pump with less force. More blood remains in the heart’s chambers after each beat which makes it difficult to keep up with the needs of the body. It does not only affect the heart chambers but also the other parts of the heart.
Dilated cardiomyopathy occurs when the left ventricle of the heart enlarges. This impairs the heart’s ability to pump blood to the rest of the body. Severe cases of this condition can lead to heart failure and other complications.
A person suffering with dilated cardiomyopathy may not notice any symptoms at first. Its symptoms can sometimes be mistaken for other medical diseases. However, dilated cardiomyopathy can be fatal. It is a leading cause of heart failure. Common symptoms include weariness and shortness of breath.
Dilated cardiomyopathy treatment may include drugs, surgical procedure to allow installation of a medical device that can assist the heart in pumping blood, or a heart transplant. Lifestyle modifications can make medications work better and possibly help delay or avoid surgery.
Symptoms
Symptoms of dilated cardiomyopathy usually become noticeable when the heart’s function deteriorates. However, in most cases, no signs and symptoms occur in early stages of the condition.
A cardiac murmur is frequently the first sign of dilated cardiomyopathy. Other signs and symptoms may include:
- Fatigue or tiredness that is out of the ordinary
- Dyspnea, or difficulty breathing while doing activity or lying down
- Edema, or swelling of the legs, ankles, foot, or abdomen
- Feeling dizzy or lightheaded
- Palpitations or fluttering of the chest
- Fainting
- Chest discomfort or pain
- Unexpected weight increase as a result of fluid retention
- Impaired capacity to exercise
Since dilated cardiomyopathy can be associated with heart failure, having chest pain that lasts longer than a few minutes or having serious breathing difficulties can be a medical emergency. Go to the nearest hospital right away. If other signs and symptoms persist, visit a doctor for diagnosis and treatment.
Some kinds of dilated cardiomyopathy are inherited, also known as familial dilated cardiomyopathy. Genetic testing is advised to those with a family member that has dilated cardiomyopathy.
Causes
Most cases of dilated cardiomyopathy have no known cause. However, many factors can cause the left ventricle to dilate and weaken. When experts identify a reason, it may be related to the following:
- Specific infections, such as myocarditis
- Congenital heart disease
- Mitral valve or aortic valve regurgitation, or other heart valve disease
- Late-stage pregnancy or immediately after delivery complications
- Hemochromatosis, or abnormally high levels of iron
- Diabetes
- Abnormal heart rhythm, or arrhythmias
- Uncontrolled high blood pressure
- Excessive weight gain
It may also be caused by:
- Alcohol-use disorder
- Use of certain medications to treat cancer
- Use of recreational drugs, such as cocaine or amphetamines
- Excessive toxin exposure, such as lead, mercury and cobalt
- Thyroid disease
- Viral infections, such as HIV and viral hepatitis
Risk factors
Several factors may affect the one’s susceptibility to dilated cardiomyopathy, such as:
- A history of dilated cardiomyopathy, heart failure, or sudden cardiac arrest in the family
- Heart muscle damage caused by illnesses such as hemochromatosis
- Heart muscle inflammation caused by immune system illnesses such as lupus
- Muscular dystrophy and other neuromuscular disorders
- Heart valve disorder
- Excessive alcohol or illegal drug use
- Chronic high blood pressure
- Stroke
- Blood clots in the heart
- Angina, or chest pain
Diagnosis
The diagnosis of dilated cardiomyopathy involves discussing the medical history and completing a physical examination. This may involve listening to the heart lungs for fluid buildup. Several tests may be required to evaluate the severity and aids healthcare providers in the treatment of dilated cardiomyopathy. This includes:
- Blood tests: Infections, drugs, or disorders such as diabetes or hemochromatosis that may cause dilated cardiomyopathy can be detected during blood test. Various blood tests can be performed to look for these.
- Echocardiogram: This is an ultrasound examination of the heart’s anatomy and function. It depicts how blood flows into and out of the heart and its valves. It can detect an enlarged left ventricle. In an echo test, a doctor takes photos of the heart’s valves and chambers using high-frequency sound waves from a hand-held wand placed on the chest. Echocardiogram is the primary test used to diagnose dilated cardiomyopathy.
- Chest X-ray: A chest X-ray reveals the shape and health of the heart and lungs. It can potentially show fluid within or around the lungs.
- Electrocardiogram (ECG or EKG): An EKG test is a quick approach to collect information to help diagnose a heart problem. It monitors, tracks, and records the electrical activity of the heart using temporary electrodes on the chest and limbs. Signal patterns can aid in the diagnosis of heart rhythm disorders or inadequate blood flow. It can reveal how quickly or slowly the heart is beating.
- Holter monitor: This device continuously records the heart’s activity for 24 hours or more. This is a portable ECG equipment that can be carried in a pocket or worn on a belt or shoulder strap during regular daily activities.
- Exercise stress test: This test is done while being active. Exercise testing can show how the heart reacts to physical exertion. Normally, the ECG is performed while riding a stationary bicycle or walking on a treadmill, to monitor the activity of the heart. A medicine that stimulates the heart in a manner similar to exercise may be administered to those with difficulties exercising.
- CT or MRI scan of the heart: Magnetic fields and radio waves are used in cardiac MRIs. A cardiac CT scan creates comprehensive images of the heart by using a succession of X-rays. These imaging procedures can reveal information about the size and activity of the heart’s pumping chambers.
- Cardiac catheterization: A biopsy can be collected during cardiac catheterization to assess for heart muscle injury. The procedure entails placing catheters into a blood artery, generally in the groin, and is guided to the heart. Dye is injected through the catheter to make the cardiac arteries more visible on X-ray imaging.
- Genetic screening or counseling: First-degree relatives may be subjected to family screening or genetic testing. This will determine if cardiomyopathy was inherited.
Treatment
There are several treatment options for dilated cardiomyopathy. It usually includes medication or surgical procedures to install a medical device that assists the heart in beating or pumping blood. The goal of the treatment is to alleviate symptoms, enhance blood flow, and avoid additional heart damage. The cause of the condition will also influence the appropriate treatment.
- Medications: Medication to improve heart function may be the first step in the treatment process. One or more medications may be prescribed to remedy the condition. They can help maintain cardiac rhythm, improve heart pumping, reduce blood pressure, avoid blood clots, and remove excess fluid from the body. These medications include:
- Blood pressure medications: Beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin II receptor blockers (ARBs) are the common medications used to lower blood pressure, enhance blood flow, and minimize the strain on the heart.
- Diuretics: Also known as water pills flushes the body of excess fluid and salt. Heart strain and breathing difficulties are usually caused by too much body fluid.
- Sacubitril/valsartan: This medication is often prescribed to treat people who have chronic heart failure. This medication combines an ARB with another type of medication to assist the heart circulate blood to the rest of the body more efficiently.
- Digoxin: This drug may alleviate the symptoms of heart failure and make it simpler to be active. It has the effect of slowing the heartbeat and can improve cardiac muscle contractions.
- Ivabradine: This medication can treat heart failure due to dilated cardiomyopathy.
- Anticoagulants (blood-thinners): These medications aid in the prevention of blood clots.
- Surgeries or other procedures: Advanced dilated cardiomyopathy can substantially affect heart function. Surgery may be required to implant a device that regulates the heart’s rhythm or assists the heart in pumping blood. A heart transplant is only necessary if drugs and other therapies for dilated cardiomyopathy no longer work.
There are several devices to treat dilated cardiomyopathy, such as:
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- Biventricular pacemaker: This medical device is designed to assist individuals who have heart failure and experience irregular heartbeats. Known as a biventricular pacemaker, it functions by providing electrical stimulation to both of the lower chambers of the heart, thereby improving the overall efficiency of the heart’s contractions.
- Implantable cardioverter-defibrillators (ICD): Cardiomyopathy can result in hazardous arrhythmias, such as those that cause the heart to cease beating. With this battery-operated device, the heart rate and rhythm are continuously monitored. When necessary, its pulse generator administers an electric shock to treat arrhythmia. The shock is carried to the heart through the leads.
- Left ventricular assist devices (LVAD): This can be used as either a long-term or short-term treatment while waiting for a heart transplant. This mechanical gadget assists a weaker heart in pumping more efficiently. LVAD is often recommended when less invasive treatments fail.
