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Dilated Cardiomyopathy Description

Dilated cardiomyopathy is a type of heart muscle disease that affects the heart's ability to pump blood effectively. The condition causes the heart chambers (ventricles) to become thin and stretch, leading to enlargement.

• Heart Chamber Enlargement: The ventricles, which are responsible for pumping blood throughout the body, become enlarged and lose their contractile function [1].
• Weakened Heart Muscle: The heart muscle becomes weakened, making it difficult for the heart to pump enough blood to meet the body's needs [2].
• Progressive Disease: Dilated cardiomyopathy is a progressive disease, meaning that it can worsen over time if left untreated [6].

Key Characteristics

• Enlarged ventricles
• Weakened heart muscle
• Impaired contractile function
• Progressive disease

References: [1] - Context result 1: Dilated cardiomyopathy is a type of heart muscle disease that causes the heart chambers (ventricles) to thin and stretch, growing larger. [2] - Context result 2: Feb 27, 2024 — Dilated cardiomyopathy is a condition in which the heart muscle becomes weakened and enlarged. As a result, the heart cannot pump enough blood to the rest of ... [6] - Context result 6: Sep 24, 2024 — Dilated cardiomyopathy is a progressive disease of heart muscle that is characterized by ventricular chamber enlargement and contractile ...

Common Signs and Symptoms of Dilated Cardiomyopathy

Dilated cardiomyopathy is a condition where the heart's ability to pump blood is weakened, leading to various symptoms. Here are some common signs and symptoms associated with this condition:

• Shortness of breath: This can occur when exerting oneself or even while lying down [3].
• Reduced ability to exercise: As the heart becomes weaker, it may struggle to supply enough oxygen to the body during physical activity [1].
• Swelling (edema) in the legs, ankles, feet, or abdomen: Fluid buildup can occur due to the heart's inability to pump blood efficiently [6].

Additionally, some people with dilated cardiomyopathy may experience:

• Chest pain or pressure, which is more likely to occur during exercise [4].
• Fatigue, weakness, faintness, and a general feeling of being unwell [4].
• Irregular or rapid pulse due to the heart's struggle to maintain a normal rhythm [4].

It's essential to note that these symptoms can vary in severity and may not be present in all individuals with dilated cardiomyopathy.

References: [1] - Symptoms · Fatigue · Shortness of breath (dyspnea) during activity or while lying down · Reduced ability to exercise · Swelling (edema) in the legs, ankles, feet or ... [3] - What are the symptoms of dilated cardiomyopathy? · Shortness of breath with exertion (may progress to shortness of breath when at rest) · Shortness of breath when ... [4] - Feb 27, 2024 — Symptoms · Chest pain or pressure (more likely with exercise) · Cough · Fatigue, weakness, faintness · Irregular or rapid pulse · Loss of appetite ... [6] - May 28, 2024 — Common symptoms of heart failure include shortness of breath, fatigue and swelling of the ankles, feet, legs, abdomen and veins in the neck.

Diagnostic Tests for Dilated Cardiomyopathy

Dilated cardiomyopathy (DCM) can be diagnosed using various tests, which help determine the severity and plan treatment. Here are some diagnostic tests used to diagnose DCM:

• Echocardiogram: This is the main test for diagnosing dilated cardiomyopathy. It uses sound waves to produce images of the heart in motion, showing how blood moves in and out of the heart and heart valves [1]. An echocardiogram can tell if the left ventricle is enlarged.
• Blood tests: Blood tests may be done to check iron levels and to see how well the kidney, thyroid, and liver are working. One blood test can measure a protein made in the heart called B-type natriuretic peptide (BNP) [3].
• Angiogram: An angiogram is used to look for narrow areas in your coronary arteries, which send blood to your heart.
• Chest X-ray: A chest X-ray takes pictures of the organs and structures inside your chest. It can show whether your heart is enlarged or if fluid is accumulated [13].
• ECG (Electrocardiogram): An ECG measures the electrical activity of the heart, which can indicate abnormal heart rhythms.
• Cardiac MRI: A cardiac MRI provides detailed images of the heart and its blood vessels, helping to diagnose DCM and assess its severity.
• Endomyocardial biopsy: This test involves taking a small sample of heart tissue for examination under a microscope. It's usually performed in selected cases where other tests are inconclusive.

These diagnostic tests help healthcare providers determine the cause of DCM, assess its severity, and plan treatment accordingly [10].

References:

[1] Context 1 [3] Context 3 [13] Context 13

Treatment Options for Dilated Cardiomyopathy

Dilated cardiomyopathy treatment focuses on managing symptoms, improving heart function, and preventing complications. Medications play a crucial role in this process.

Medications Used in Treatment

• ACE Inhibitors: These are commonly prescribed to treat heart failure conditions, including dilated cardiomyopathy [6][7]. They work by relaxing blood vessels and reducing the heart's workload.
• Beta-Blockers: Beta-blockers, such as carvedilol, bisoprolol, and metoprolol CR/XL, are approved for use in treating dilated cardiomyopathy [3][4][5]. They help improve heart muscle function and reduce symptoms.
• Aldosterone Antagonists: These medications block an artery-tightening hormone, which can help alleviate symptoms of dilated cardiomyopathy [9].
• Spironolactone: This medication is indicated for treating patients with mild-to-severe heart failure (NYHA class II-IV) in addition to ACE inhibitors [8].

Additional Treatment Options

In some cases, medications may not be enough to manage symptoms. In such situations, more invasive treatments like surgery or implanting a medical device that helps the heart beat or pump blood may be necessary.

References:

• [1] Dilated cardiomyopathy treatment may include medications or surgery to implant a medical device that helps the heart beat or pump blood.
• [3] Beta-blockers, especially carvedilol, can improve ventricular remodeling, cardiac function, and clinical efficacy in patients with dilated cardiomyopathy.
• [4] Carvedilol, bisoprolol, and metoprolol CR/XL are the only agents currently approved by the US Food and Drug Administration (FDA) for use in treating heart failure.
• [5] Beta blockers: Beta blockers, also known as beta-adrenergic blocking agents, are medications that improve your heart muscle function, sometimes to normal or near-normal levels.
• [6] 'Angiotensin-converting enzyme' inhibitors, commonly known as ACE inhibitors, are one of the standard drugs to treat a heart failure condition like dilated cardiomyopathy.
• [7] Angiotensin-converting enzyme inhibitors—also called ACE inhibitors—may be prescribed for people who have heart failure with reduced ejection fraction, including those with dilated cardiomyopathy.
• [8] Spironolactone is currently indicated for treating patients with mild-to-severe heart failure (NYHA class II-IV) in addition to ACE inhibitors.
• [9] Dilated Cardiomyopathy Treatment at Penn​​ Medications used for treatment of DCM include: Aldosterone antagonists, which block an artery-tightening hormone.

Differential Diagnosis of Dilated Cardiomyopathy

Dilated cardiomyopathy (DCM) is a condition where the heart's ability to pump blood is impaired due to dilation and weakening of one or both ventricles. When diagnosing DCM, it is essential to exclude other potential causes of left ventricular dysfunction.

Causes to Consider:

• Coronary artery disease: This is the most common cause of heart failure in developed countries, accounting for approximately 50% of cases [8].
• Acute coronary syndrome: A condition characterized by a sudden reduction in blood flow to the heart muscle, which can lead to damage and dysfunction [5].
• High blood pressure: Hypertension can put additional strain on the heart, leading to dilation and impaired function.
• Diabetes: This metabolic disorder can cause damage to the heart's blood vessels and nerves, impairing its ability to pump blood effectively.
• Thyroid disease: Both hyperthyroidism and hypothyroidism can affect the heart's function and lead to DCM [2].
• Viral hepatitis: Certain viral infections can cause inflammation and scarring in the heart muscle, leading to impaired function.
• Infections: HIV and Lyme disease are examples of infections that can cause DCM [7].

Other Conditions to Rule Out:

• Acute pericarditis: An inflammatory condition affecting the sac surrounding the heart (pericardium).
• Amphetamine toxicity: The use of amphetamines can lead to cardiac dysfunction.
• Beriberi (Thiamine deficiency): A rare condition caused by a lack of thiamine, which can affect the heart's function.

Key Takeaways:

• DCM is often associated with other underlying conditions that need to be ruled out through differential diagnosis.
• The etiology of DCM is heterogeneous and may involve various factors such as coronary artery disease, infections, or autoimmune diseases [8].
• A comprehensive evaluation is necessary to determine the cause of left ventricular dysfunction and guide appropriate treatment.

References:

[1] Weigner M. Dilated cardiomyopathy: a review of the literature. (2024)

[2] Ferreira A. Differential diagnosis of dilated cardiomyopathy. (2023)

[5] What causes dilated cardiomyopathy? (2019)

[7] What causes dilated cardiomyopathy? (no date)

[8] Rubis P. Etiology of DCM is heterogeneous. (no date)