Dilated Cardiomyopathy: Symptoms, Diagnosis and Treatment
What is dilated cardiomyopathy?
Dilated cardiomyopathy is a heart muscle disorder in which the heart chambers, particularly the left ventricle, enlarge and the heart's ability to contract is reduced. It may cause heart failure, arrhythmias and an increased risk of blood clots. Its causes and clinical course vary between patients.
What are the symptoms?
- Breathlessness during walking or climbing stairs.
- Fatigue and reduced exercise tolerance.
- Swelling of the ankles and legs.
- Breathlessness when lying flat or waking at night short of breath.
- Palpitations, dizziness or fainting.
- Abdominal swelling or rapid weight gain from fluid retention.
Some patients have no symptoms in the early stages, and the condition is found on imaging.
What causes it?
Causes include inherited genetic changes, myocarditis, excessive alcohol exposure, certain cancer treatments or other toxic effects, and prolonged rapid heart rhythms. Some cases arise during pregnancy or after delivery. Endocrine, metabolic and nutritional disorders can also contribute. Sometimes no specific cause is found.
Coronary artery disease and important valve disease must be assessed because they can also cause an enlarged heart with reduced pumping function.
How is it diagnosed?
Clinical assessment includes symptoms, medication and substance exposure, previous illnesses and a family history of cardiomyopathy or unexplained sudden death.
ECG and rhythm monitoring
An ECG and Holter recording can identify arrhythmias and conduction abnormalities.
Echocardiography
Ultrasound evaluates chamber size, ejection fraction, valve function and other features of cardiac performance.
Cardiac MRI and further tests
MRI can help characterise scar, inflammation and the pattern of myocardial disease. Blood tests and coronary evaluation are selected according to the suspected cause. Genetic counselling and testing may be appropriate when an inherited condition is suspected.
How is it treated?
Treatment targets the cause, heart failure symptoms and the risk of complications. For heart failure with reduced ejection fraction, treatment commonly includes an ARNI or an ACE inhibitor/ARB, an evidence-based beta blocker, a mineralocorticoid receptor antagonist and an SGLT2 inhibitor, when appropriate. Diuretics help relieve fluid retention.
Medicines and doses are adjusted to blood pressure, kidney function, potassium levels and clinical tolerance. Anticoagulants are used for specific indications, such as atrial fibrillation or an intracardiac clot; an enlarged heart alone does not mean that everyone needs anticoagulation.
Devices and advanced treatment
An ICD may be appropriate for selected patients at risk of dangerous ventricular arrhythmias. Cardiac resynchronisation therapy may help selected patients with electrical dyssynchrony. Advanced heart failure may require assessment for mechanical support or transplantation.
Can heart function recover?
Some patients improve substantially when the cause is treatable and appropriate therapy is started. Others need lifelong management. Improvement in ejection fraction does not mean that medication can be stopped without specialist advice.
Should relatives be screened?
When an inherited cardiomyopathy is suspected or confirmed, first-degree relatives may need clinical screening and, where appropriate, genetic counselling and testing.
Daily life and warning signs
Take medication regularly, monitor weight as advised, avoid smoking and discuss alcohol, exercise and fluid intake with your clinician. Severe breathlessness at rest, fainting, ongoing chest pain or a sustained rapid heartbeat requires urgent assessment. Call 112 for an emergency.
Assoc. Prof. Sezen Bağlan Uzunget, MD — Cardiologist
This information is educational. Investigation and treatment are individualised.
Türkçe: Dilate Kardiyomiyopati