Dilated cardiomyopathy

  • Definition
    • Cardiomyopathy is disease in which the heart muscle becomes weakened, stretched, or has another structural problem.

      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 the body.

      There are many types of cardiomyopathy. Dilated cardiomyopathy is the most common form.

      Dilated cardiomyopathy
  • Alternative Names
    • Cardiomyopathy - dilated; Primary cardiomyopathy; Diabetic cardiomyopathy; Idiopathic cardiomyopathy; Alcoholic cardiomyopathy

  • Causes
    • The most common causes of dilated cardiomyopathy are:

      • Heart disease caused by a narrowings or blockages of the coronary arteries
      • Poorly controlled high blood pressure

      There are many other causes of dilated cardiomyopathy, including:

      • Alcohol or cocaine abuse
      • Diabetes, thyroid disease, or hepatitis
      • Medicines that can be toxic to the heart, such as drugs used to treat cancer
      • Abnormal heart rhythms in which the heart beats very fast for a long period of time
      • Autoimmune illnesses
      • Conditions that run in families
      • Infections that involve the heart muscle
      • Heart valves that are either too narrow or too leaky
      • During the last month of pregnancy, or within 5 months after the baby is born.
      • Exposure to heavy metals such as lead, arsenic, cobalt, or mercury

      This condition can affect anyone at any age. However, it is most common in adult men.

  • Symptoms
    • Symptoms of heart failure are most common. They most often develop slowly over time. However, sometimes symptoms start very suddenly and are severe.

      Common symptoms are:

      • Chest pain or pressure (more likely with exercise)
      • Cough
      • Fatigue, weakness, faintness
      • Irregular or rapid pulse
      • Loss of appetite
      • Shortness of breath with activity or after lying down (or being asleep) for a while
      • Swelling of feet and ankles
  • Exams and Tests
    • During the exam, the health care provider may find:

      • The heart is enlarged.
      • Lung crackles (a sign of fluid buildup), heart murmur, or other abnormal sounds.
      • The liver is possibly enlarged.
      • Neck veins may be bulging.

      A number of laboratory tests may be done to determine the cause:

      • Antinuclear antibody (ANA), erythrocyte sedimentation rate (ESR), and other tests to diagnose autoimmune illnesses
      • Antibody test to identify infections such as Lyme disease and HIV
      • Iron tests of the blood
      • Serum TSH and T4 test to identify thyroid problems
      • Tests for amyloidosis

      Heart enlargement or other problems with the structure and function of the heart (such as weak squeezing) may show up on these tests. They may also help diagnose the exact cause of the problem:

      Heart biopsy, in which a small piece of heart muscle is removed, may be needed depending on the cause. However, this is rarely done.

  • Treatment
    • Things you can do at home to take care of your condition include:

      Most people who have heart failure need to take medicines. Some medicines treat your symptoms. Others may help prevent your heart failure from becoming worse, or may prevent other heart problems.

      Procedures and surgeries you may need include:

      • A pacemaker to help treat slow heart rates or help your heartbeat stay in sync
      • A defibrillator that recognizes life-threatening heart rhythms and sends an electrical pulse to stop them
      • Heart bypass (CABG) surgery or angioplasty to improve blood flow to the damaged or weakened heart muscle
      • Valve replacement or repair

      For advanced cardiomyopathy:

      • A heart transplant may be recommended if standard treatments have not worked and heart failure symptoms are very severe.
      • Placement of a left ventricular assist device or artificial heart may be considered.

      Chronic heart failure becomes worse over time. Many people who have heart failure will die from the condition. Thinking about the type of care you may want at the end of life and discussing these issues with loved ones and your health care provider is important.

  • Outlook (Prognosis)
    • Heart failure is most often a chronic illness, which may get worse over time. Some people develop severe heart failure, in which medicines, other treatments, and surgery no longer help. Many people are at risk for deadly heart rhythms, and may need medicines or a defibrillator.

  • When to Contact a Medical Professional
    • Call your provider if you have symptoms of cardiomyopathy.

      Get emergency medical help right away if you have chest pain, palpitations or fainting.

  • References
    • Falk RH, Hershberger RE. The dilated, restrictive, and infiltrative cardiomyopathies In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 65.

      Mckenna WJ, Elliott P. Diseases of the myocardium and endocardium. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 60.