Cardiomyopathy - dilated

Definition

Dilated cardiomyopathy is a condition in which the heart becomes weakened and enlarged, and cannot pump blood efficiently. The decreased heart function can affect the lungs, liver, and other body systems.

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

See also:

• Alcoholic cardiomyopathy
• Hypertrophic cardiomyopathy
• Ischemic cardiomyopathy
• Peripartum cardiomyopathy
• Restrictive cardiomyopathy

Alternative Names

Causes

There are many causes of dilated cardiomyopathy. They may include nutritional deficiencies, valvular heart disease, anemia, stress, viral infections (rare), alcoholism (alcoholic cardiomyopathy), and coronary artery disease.

Dilated cardiomyopathy occurs in an estimated 2 out of 100 people. It can affect anyone of any age, although it is most common in adult men.

Risk factors include obesity, cocaine use, a personal or family history of cardiac disorders (such as myocarditis), and alcoholism.

Symptoms

• Swelling of feet and ankles
• Swelling of the abdomen
• Pronounced neck veins
• Loss of appetite
• Shortness of breath, especially with activity
• Shortness of breath which occurs after lying down for a while
• Fatigue, weakness, faintness
• Sensation of feeling the heart beat (palpitations)
• Pulse may feel irregular or rapid
• Decreased alertness or concentration
• Cough
• Low urine production
• Need to urinate at night

Note: Symptoms of heart failure often develop gradually. Some chest pain may also be associated with this disease.

Exams and Tests

Cardiomyopathy is usually discovered on examination and testing for the cause of heart failure. Tapping the area with the fingers and feeling the area may indicate enlargement of the heart. Listening to the chest with a stethoscope reveals lung crackles, heart murmur, or other abnormal sounds. The liver may be enlarged. Neck veins may be distended.

Heart enlargement, congestion of the lungs, decreased movement/functioning of the heart, or heart failure may show on:

• Echocardiogram
• Chest x-ray
• Chest CT scan
• Cardiac catheterization and coronary angiography
• Nuclear heart scan (MUGA, RNV)

An ECG may show conduction disturbances or arrhythmias, and may indicate enlargement of the ventricles. Heart biopsy may be helpful to distinguish dilated cardiomyopathy from other diseases. Lab tests vary depending on the suspected cause.

Treatment

The patient may need to stay in the hospital until acute symptoms start to go away. Treatment is focused on relief of symptoms. Digitalis, vasodilators (drugs that dilate blood vessels), ACE-inhibitors, diuretics (water pills), nutritional supplements, and other medications may be prescribed to reduce symptoms.

The underlying cause should be treated. Some patients may require a biventricular pacemaker. An implantable defibrillator may also be needed to correct any severe arrhythmias (abnormal heart rhythms). A biventricular pacemaker with defibrillation capabilities is available.

A low-salt diet may be prescribed, and fluid may be restricted in some cases. The patient can usually continue their regular activities, if tolerated.

Daily monitoring of body weight may be advised. Weight gain of 3 or 4 pounds or more over 1 or 2 days may indicate fluid accumulation.

Smoking and drinking alcohol may worsen the symptoms.

If the heart function remains poor, a heart transplant may be considered.

Outlook (Prognosis)

The outcome varies. Some patients remain in a stable condition for long periods, some continue to get gradually sicker, and others quickly get worse. Cardiomyopathy can only be corrected if the underlying disease can be cured.

Possible Complications

• Congestive heart failure
• Arrhythmias
• Pulmonary edema
• Side effects of medications, including:
  • Low blood pressure
  • Lightheadedness and fainting
  • Lupus reaction (a group of symptoms including a skin rash and arthritis)
  • Headache
  • Gastrointestinal upset

When to Contact a Medical Professional

Call your health care provider if you have symptoms of cardiomyopathy.

If chest pain, palpitations, or faintness develop seek emergency medical treatment immediately.

Prevention

Eat a well-balanced and nutritious diet, exercise to improve heart fitness, stop smoking, and minimize alcohol consumption.

Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 7th ed. St. Louis, Mo: WB Saunders; 2005: 1659-1692.

Marx J. Rosen's Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002: 1142-1143.

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