Dilated cardiomyopathy describes a form of heart muscle disease in which the left ventricle in particular becomes dilated. Affected individuals suffer from cardiac arrhythmias and heart failure. In most cases, it is not possible to cure dilated cardiomyopathy, but only to alleviate the symptoms.
What is dilated cardiomyopathy?
Dilated cardiomyopathy is a heart muscle disease. The term “dilate” comes from Latin and means to widen or expand. Accordingly, dilated cardiomyopathy is characterized by an enlargement of the heart cavities. As a result, the heart wall becomes flabbier and less powerful, which noticeably reduces the heart’s pumping capacity. In addition, it becomes stiffer and loses elasticity, so that it is also more difficult for the heart chambers to be filled with blood. As a result, too little blood is pumped into the body’s circulation, causing sufferers to complain of a significant reduction in physical performance. The structure of the heart muscle is altered and may become interspersed with scar tissue.
Causes
The causes of dilated cardiomyopathy often vary widely and cannot be clearly identified. The most common cause known to trigger dilated cardiomyopathy is marked coronary artery disease. In this case, the vessels are severely constricted, so that the heart muscle is not supplied with sufficient oxygen. In these situations, a heart attack also frequently occurs. As a result, remodeling processes occur in the functioning parts of the heart muscle, often leading to dilation of the left ventricle. Other possible causes include infections of the heart muscle, cardiac arrhythmias and nerve diseases. Long-term poorly controlled diabetes mellitus, amyloidosis (disturbed production and deposition of proteins) or rare muscle diseases such as muscular dystrophy type Duchenne (DMD) can trigger dilated cardiomyopathy. Furthermore, excessive abuse of medications, alcohol and drugs (cocaine), genetic causes, various environmental factors can
or drugs used for chemotherapy can be the reason for the heart disease.
Symptoms, complaints, and signs
If dilated cardiomyopathy is present, 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 forward failure. In addition, cardiac insufficiency is usually associated with backward failure. The blood backs up in the blood vessels leading to the heart. The heart fails to work through the preload. Dilated cardiomyopathy initially manifests itself with the typical symptoms of progressive left heart failure. Those affected suffer from fatigue and reduced performance as well as a general feeling of weakness. Those affected also complain of shortness of breath, especially during physical exertion. If dilated cardiomyopathy is already very advanced, shortness of breath may likewise occur at rest.
Diagnosis and course
Dilated cardiomyopathy is diagnosed on the basis of the symptoms described and a physical examination. Echocardiography (ultrasound examination of the heart) is the most important examination in terms of clarification. It can be used to assess the size, shape, motion and pumping function of the heart. In addition, it is possible to check the blood flow and thus the tightness of the heart valves. Furthermore, magnetic resonance imaging can provide images of the heart structures in a high resolution. Tissue remodeling can also be assessed well in this way. If the diagnosis cannot yet be made conclusively, a myocardial biopsy is performed. In this procedure, a tissue sample is taken from the heart muscle and then examined under a microscope. If dilated cardiomyopathy is present, typical heart muscle changes are detected. In the course of the disease, dilated cardiomyopathy often also affects the right ventricle (global insufficiency). Patients then complain of fluid retention (edema), especially in the legs, in addition to the pre-existing symptoms. Since the blood flow in the atria and ventricles is disturbed, blood clots form more easily in patients with the disease compared to healthy people.If this becomes detached, the arteries can become blocked. The possible consequences are severe complications such as pulmonary infarction or stroke. Progressive dilated cardiomyopathy can also lead to severe arrhythmias, circulatory collapse and, in the worst case, sudden cardiac death.
Complications
The disease causes severe discomfort and disturbances of the heart. In the worst case, these can also lead to the death of the patient if heart failure occurs that is not properly treated. Not infrequently, the cardiac arrhythmias also result in an undersupply of blood to the organs, causing them to become paralyzed or damaged. In most cases, those affected also suffer from a general feeling of weakness and fatigue. This cannot be compensated by sleep. Physically strenuous activities or sports can also no longer be performed without further ado, severely restricting the affected person’s everyday life and significantly reducing the quality of life. Circulatory collapse can also lead to sudden cardiac death. Thus, the patient must avoid stressful situations and must not expose himself to unnecessary stress. Causal treatment is not possible, so there are no further complications in this case. The heart must usually be spared and supported, and a pacemaker may also be installed. Life expectancy is reduced by the disease in most cases.
When should you see a doctor?
A physician should be consulted if there is shortness of breath, fatigue, and a general feeling of weakness. Based on the symptoms described and an ultrasound examination of the heart, the physician can determine whether dilated cardiomyopathy is present and, if necessary, directly suggest appropriate therapy. Occasionally, a longer hospital stay is required for this. Individuals who already have coronary artery disease, cardiac arrhythmias, or nerve disease are particularly susceptible to heart conditions such as dilated cardiomyopathy. So are diabetics with poorly controlled treatment, as well as amyloidosis and muscular dystrophy patients. There is an increased risk of acute heart disease after excessive use of medications, alcohol, and drugs, as well as taking certain medications. Anyone who belongs to these risk groups should in any case talk to the doctor in charge in the event of symptoms mentioned above. In severe cases, the nearest hospital should be visited immediately. If signs of a cardiac arrhythmia are noticed, the emergency medical service is the right contact. In the event of complications such as circulatory collapse and heart attack, the emergency physician must be called in immediately. Until medical help arrives, first aid measures must be taken.
Treatment and therapy
Dilated cardiomyopathy requires urgent treatment, but no therapy exists that treats the causes. If a possible cause, such as coronary artery disease, is known, it is important that it be treated. In addition, if possible, all medications that can lead to myocarditis should be discontinued. The goal of therapy for dilated cardiomyopathy is to reduce symptoms and curb the progression of impaired pumping function of the heart. Medication is usually ACE inhibitors, diuretics and digitalis preparations. 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. Excess weight should be reduced and stress should be avoided. Furthermore, it is 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 will be overloaded. Sometimes surgery or implantation of a pacemaker cannot be avoided. Dilated cardiomyopathy is ultimately an incurable disease.
Outlook and prognosis
Dilated cardiomyopathy has a poor prognosis. Even under favorable conditions and avoidance of various risk factors, the patient’s life expectancy is greatly reduced. The degree of heart failure is critical to the course of the disease.Without the use of drug treatment, life expectancy is shortened by another. The administration of drugs or the insertion of a pacemaker can stabilize and support cardiac activity. The treatment measures are aimed at prolonging 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. Nearly 90% of those suffering from dilated cardiomyopathy die within the first ten years after diagnosis. The remaining 10% normally die in the following five years. The heart muscle disease leads to cardiac insufficiency and ultimately to sudden cardiac death. Avoiding obesity, alcohol and nicotine can delay the progression of the disease. Likewise, the course of the disease can be favorably influenced by refraining from physical overexertion, dealing with emotional challenges, or reducing various stressors. Nevertheless, because the damage to the myocardium cannot be corrected, the patient will die prematurely.
Prevention
To prevent dilated cardiomyopathy, a healthy lifestyle and regular exercise are very important. Reducing excess weight, avoiding nicotine and alcohol, maintaining low blood pressure, avoiding stress, and preventing or treating diabetes or other metabolic diseases all play important roles in this regard.
Follow-up
As a chronic cardiac disease, dilated cardiomyopathy requires close follow-up after acute care. This is performed by the cardiologist or internist, usually also in cooperation with the treating family physician. The patient’s cooperation is absolutely essential, since, as in the case of other heart diseases, the patient’s lifestyle is closely related to the condition and the course of the disease. From a medical point of view, the most important thing is to keep regular check-ups. Ultrasound of the heart, stress ECG and imaging procedures such as MRI are among the classic examinations. Attendance at special cardiac sports groups may also be included in the scope of follow-up care for dilated cardiomyopathy. In everyday life, patients can work on their fitness by incorporating moderate physical activities into their daily routine. Sports should be discussed with the treating physicians. Over- and under-exertion should be avoided. A healthy diet makes a significant contribution to the well-being of heart patients. Low fat and the avoidance of flatulent foods are important here. Sufficient drinking should also be ensured. Smoking should be avoided at all costs to protect the blood vessels. In addition, alcohol consumption is only permitted to a very limited extent. An amount of sleep, which is sufficient, serves the regeneration and is also important in the context of aftercare.
This is what you can do yourself
Everyday life and self-help to improve the living situation in a diagnosed dilated cardiomyopathy depend on the causative factors and on the severity of the disease. Dilated cardiomyopathy is characterized by dilatation of the left or right ventricle, which is usually associated with a limitation of the heart’s pumping ability that can lead to typical sequelae. In addition to any necessary medication, an adjustment of behavior in everyday life can help to stop the progression of the disease and, depending on the severity of the disease, to lead an almost unimpaired life. One of the most important measures, regardless of the cause of the disease, is a change in diet to a light, low-salt diet. Together with the physician, possible and recommendable sports activities should be defined, which support the circulation and help to inhibit the cardiomyopathy in its further progress. Almost all other measures also serve as prevention. First and foremost is the avoidance of chronic stress, because constant stress situations lead to a high concentration of stress hormones via the sympathetic nervous system, which are no longer completely eliminated and, among other things, are often the trigger of 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 can also help.It is also advisable to avoid being overweight and to avoid nicotine and alcohol as much as possible.