The dilated cardiomyopathy describes a form of heart muscle disease in which in particular the left ventricle expanded. Those affected suffer from cardiac arrhythmias and cardiac insufficiency. In most cases it is not possible to cure dilated cardiomyopathy, only to alleviate the symptoms.
What is dilated cardiomyopathy?
Abbreviated as DCM on abbreviationfinder, dilated cardiomyopathy is a heart muscle disease. The term “dilate” comes from Latin and means to expand or expand. As a result, dilated cardiomyopathy is characterized by an enlargement of the heart cavities. As a result, the heart wall becomes slacker and more weak, which means that the heart’s pumping capacity is noticeably reduced.
In addition, it becomes stiffer and loses its elasticity, making it more difficult for the heart chambers to fill with blood. As a result, too little blood is pumped into the body’s circulation, so that those affected complain of a significant reduction in physical performance. The structure of the heart muscle is changed and scar tissue can be penetrated.
The causes of dilated cardiomyopathy are often very different and cannot be clearly identified. The most common cause known to trigger dilated cardiomyopathy is pronounced coronary artery disease.
In this case, the vessels are severely narrowed, so that the heart muscle is not supplied with enough oxygen. Heart attacks are also common in these situations. As a result, remodeling processes occur in the functioning parts of the heart muscle, which often lead to the expansion of the left ventricle.
Other possible causes include infections of the heart muscle, cardiac arrhythmias and nerve disorders. Long-term poorly controlled diabetes mellitus, amyloidosis (impaired production and deposits of proteins) or rare muscle diseases such as Duchenne muscular dystrophy (DMD) can trigger dilated cardiomyopathy.
Furthermore, excessive drug, alcohol and drug abuse (cocaine), genetic causes, various environmental factors or drugs used for chemotherapy can be the reason for heart disease.
Symptoms, ailments & signs
If there is dilated cardiomyopathy, the patients often have the typical symptoms of heart failure (cardiac insufficiency). Due to its limited performance, the heart does not manage to supply the organism with sufficient blood and thus oxygen. This is referred to as a forward failure.
In addition, heart failure is usually associated with backward failure. The blood builds up in the blood vessels that lead to the heart. The heart fails to work off the preload. Dilated cardiomyopathy manifests itself first of all with the typical symptoms of advancing left heart failure.
Those affected suffer from tiredness and decreased performance as well as a general feeling of weakness. Those affected also complain of shortness of breath, especially during physical exertion. In the case of an already very advanced dilated cardiomyopathy, dyspnoea can also occur at rest.
Diagnosis & course
Dilated cardiomyopathy is diagnosed based on the symptoms described and a physical exam. The echocardiogram (ultrasound of the heart) is the most important investigation into the investigation. This allows the size, shape, movement and pumping function of the heart to be assessed.
It is also possible to check the blood flow and thus the tightness of the heart valves. Furthermore, images of the heart structures can be delivered in a high resolution by means of magnetic resonance tomography. The tissue remodeling can also be assessed well in this way. If the diagnosis cannot be clearly established, a myocardial biopsy is performed.
A tissue sample is taken from the heart muscle and then examined under a microscope. If there is dilated cardiomyopathy, typical heart muscle changes are found. In the course of the dilated cardiomyopathy often also affects the right ventricle (global insufficiency).
In addition to the existing symptoms, patients then complain of fluid retention (edema), especially in the legs. Since the blood flow in the auricles and chambers of the heart is disturbed, blood clots form more easily in sick people than in healthy people. If this loosens, the arteries can become blocked.
The possible consequences are serious complications such as a pulmonary infarction or stroke. Progressive dilated cardiomyopathy can also lead to severe arrhythmias, circulatory collapse and, in the worst case, sudden cardiac death.
The disease causes severe discomfort and disorders of the heart. In the worst case, these can also lead to the patient’s death if heart failure occurs that is not properly treated. It is not uncommon for the cardiac arrhythmias to lead to an insufficient supply of blood to the organs, so that they are paralyzed or damaged.
Most of the time, those affected also suffer from a general feeling of weakness and tiredness. This cannot be compensated for by sleep. Even physically strenuous activities or sports can no longer be carried out without further ado, which severely restricts the everyday life of the person concerned and significantly reduces the quality of life. A circulatory collapse can also lead to sudden cardiac death.
In this way, the patient must avoid stressful situations and must not expose himself to unnecessary stress. A causal treatment is not possible, so that there are no further complications. The heart usually needs to be spared and supported, and a pacemaker can also be installed. Life expectancy is reduced in most cases by the disease.
When should you go to the doctor?
A doctor should be consulted in the event of breathlessness, tiredness and a general feeling of weakness. Based on the symptoms described and an ultrasound examination of the heart, the doctor can determine whether a dilated cardiomyopathy is present and, if necessary, directly suggest a suitable therapy.
Occasionally an extended hospital stay is required for this. People who already have coronary artery disease, cardiac arrhythmias or nerve disorders are particularly prone to heart diseases such as dilated cardiomyopathy. Likewise, diabetics with poorly controlled treatment as well as amyloidosis and muscular dystrophy patients.
There is an increased risk of acute heart disease after excessive drug, alcohol and drug use and the use of certain medications. Anyone who belongs to these risk groups should speak to the responsible doctor in any case if the symptoms are mentioned. In severe cases, the nearest clinic should be visited immediately.
If signs of a cardiac arrhythmia are noticed, the medical emergency service is the right contact. In the event of complications such as circulatory collapse and heart attack, the emergency doctor must be called in immediately. Until medical help arrives, first aid measures must be taken.
Treatment & Therapy
Dilated cardiomyopathy needs urgent treatment, but no therapy exists to treat the cause. If a possible cause, such as coronary artery disease, is known, it is important that it be treated. In addition, if possible, all drugs that can lead to heart muscle inflammation should be discontinued.
The aim of therapy for dilated cardiomyopathy is to reduce the symptoms and curb the progression of the impaired pumping function of the heart. ACE inhibitors, diuretics, and digitalis preparations are usually given as medication. Beta blockers are also used in some cases.
The dose is usually increased gradually so that the body and thus also the heart are not unnecessarily stressed. Physical performance can be supported with a healthy and balanced, but low-salt diet. Obesity should be reduced and stress should be avoided. It is also advisable to avoid alcohol and nicotine, as these have a damaging effect on the heart muscle.
In addition, the amount of fluid must be reduced to 1.5 to a maximum of 2 liters per day, otherwise the heart is stressed too much. Sometimes surgery or the implantation of a pacemaker cannot be avoided. Dilated cardiomyopathy is ultimately an incurable disease.
Outlook & forecast
Dilated cardiomyopathy has a poor prognosis. Even under favorable conditions and the avoidance of various risk factors, the life expectancy of the patient is greatly reduced. The degree of heart failure is decisive for the course of the disease. Without the use of drug treatment, life expectancy is reduced by another.
The heart can be stabilized and supported by the administration of medicines or the use of a pacemaker. The treatment measures are aimed at extending life and maintaining the usual quality of life for as long as possible.
Despite all efforts and the possibilities of scientific progress, a cure for this disease is currently not possible. Almost 90% of those with dilated cardiomyopathy die within the first ten years of being diagnosed. The remaining 10% normally in the following five years.
The heart muscle disease leads to heart failure and ultimately to sudden cardiac death. Avoiding obesity, alcohol and nicotine can delay the progression of the disease.
The course of the disease can also be positively influenced by not exercising physical exertion, dealing with emotional challenges or reducing various stressors. Since the damage to the heart muscle cannot be corrected, the patient dies prematurely.
To prevent dilated cardiomyopathy, a healthy lifestyle and regular exercise are very important. The reduction of excess weight, the renouncement of nicotine and alcohol, a low blood pressure, the avoidance of stress as well as the prevention or treatment of diabetes or other metabolic diseases play an important role.
As a chronic heart disease, dilated cardiomyopathy must be followed up closely after acute care. This is carried out by the cardiologist or internist, usually also in cooperation with the treating family doctor. Co-operation of the patient is absolutely necessary, because the way of life, like with other diseases of the heart, is also closely related to the state of health and the course of the disease.
From a medical point of view, the regular controls must be observed. Ultrasound of the heart, stress ECG and imaging procedures such as MRI are among the classic examinations. Attending special cardiac sports groups can also be included in the follow-up care for dilated cardiomyopathy.
In everyday life, the patient can work on his fitness by integrating moderate physical activities into his daily routine. Sport should be discussed with the attending physician. Avoid over- and under-demanding. A healthy diet contributes significantly to the well-being of heart patients.
Little fat and avoiding flatulent foods are important here. It is also important to ensure that you drink enough water. Smoking must be avoided at all costs to protect the blood vessels. In addition, the consumption of alcohol is only permitted to a very limited extent. A sufficient amount of sleep is used for regeneration and is also important in the context of aftercare.
You can do that yourself
Everyday life and self-help to improve the living situation with a diagnosed dilated cardiomyopathy depend on the causal factors and the severity of the disease. Dilated cardiomyopathy is characterized by an expansion of the left or right ventricle, which is usually associated with a reduction in the heart’s pumping capacity, which can lead to typical secondary diseases.
In addition to the necessary medication, adjusting your behavior in everyday life can help stop the progression of the disease and, depending on the severity of the disease, lead an almost unimpaired life.
One of the most important measures, regardless of the cause of the disease, is a change in diet to light, low-salt food. Possible and recommendable sports activities should be defined together with the doctor that support the circulation and help to inhibit the further progress of the cardiomyopathy.
Almost all other measures also serve as a preventive measure. First and foremost, the avoidance of chronic stress should be mentioned, because constant stressful situations lead to a high concentration of stress hormones via the sympathetic nervous system, which are no longer completely broken down and, among other things, often trigger primary high blood pressure (hypertension).
High blood pressure should be avoided at all costs. In addition to medication, relaxation techniques such as yoga and meditation also help. It is also advisable to avoid being overweight and to avoid nicotine and alcohol as much as possible.