Dilated cardiomyopathy (DCM) is a serious heart muscle disease that affects your heart’s pumping function. In this condition, the heart muscle weakens and the ventricles, which are the lower chambers of the heart, enlarge and grow. The enlarged ventricles become unable to pump adequate blood to the body with each beat, leading to symptoms such as fatigue and shortness of breath.
What is Dilated Cardiomyopathy?
Dilated cardiomyopathy is a disease that reduces your heart’s contractile strength and causes the heart chambers to enlarge. In this disease, the heart chambers, especially the left ventricle, enlarge, their walls thin and weaken. This condition can lead to heart failure by reducing the heart’s ability to pump blood to the body. The disease usually originates from the heart muscle itself and appears as a primary problem. Dilated cardiomyopathy can develop due to various factors such as age, genetics, infections, and lifestyle.
What are the Causes of Dilated Cardiomyopathy?
The causes of dilated cardiomyopathy may not always be clearly determined. However, no definite cause can be found in approximately half of patients, and this condition is called “idiopathic.” Known and possible causes include:
- Genetic Factors: The risk of the disease occurring within families is high. Mutations in genes of proteins that make up the heart muscle can lead to the disease.
- Coronary Artery Disease: As a result of narrowing of the vessels feeding the heart, the heart muscle cannot get enough oxygen and becomes damaged. This condition can weaken the heart muscle over time even if it does not lead to a heart attack.
- Alcohol and Drug Use: Chronic and excessive alcohol consumption and use of substances like cocaine can damage the heart muscle.
- Viral Infections: Some viruses (especially those that cause inflammation of the heart muscle called myocarditis) can cause permanent damage to the heart muscle.
- Autoimmune Diseases: The body’s immune system attacking the heart muscle.
- Blood Pressure: High blood pressure that remains uncontrolled for a long time causes the heart to work excessively, leading to muscle weakening.
- Thyroid Diseases: Under or overactivity of the thyroid gland can affect the heart.
- Pregnancy: Rarely, peripartum cardiomyopathy, which can occur in the last months of pregnancy or after delivery, is a type of dilated cardiomyopathy.
What are the Symptoms of Dilated Cardiomyopathy?
The symptoms of dilated cardiomyopathy may be mild or absent in the early stages of the disease. However, as the disease progresses, symptoms become more pronounced due to weakening of the heart muscle. The most common symptoms are:
- Shortness of Breath: Difficulty breathing especially during physical activity or when lying down. Waking up at night due to shortness of breath is a frequently seen condition.
- Fatigue and Weakness: Unexplained, constant fatigue and feeling of energy deficiency due to the body not getting enough oxygen.
- Swelling in Ankles, Legs, and Abdomen (Edema): When the heart cannot pump enough blood, blood accumulates in vessels and fluid leaks into tissues, causing swelling.
- Heart Palpitations: Feeling of the heart working irregularly, rapidly, or skipping beats.
- Dizziness and Fainting: Can occur when not enough blood reaches the brain.
- Chest Pain: There may be discomfort or pain in the chest, especially during exertion. May not occur in every patient.
How is Dilated Cardiomyopathy Diagnosed?
Dilated cardiomyopathy diagnosis is made through a combination of the patient’s medical history, physical examination, and various diagnostic tests.
- Echocardiography: Known as heart ultrasound, this test clearly shows the size of heart chambers, thickness of heart walls, and the heart’s pumping function (ejection fraction).
- Electrocardiogram (ECG): Measures the electrical activity of the heart and can detect rhythm disorders or heart muscle damage.
- Chest X-ray: Shows the size of the heart and whether there is fluid accumulation (edema) in the lungs.
- Blood Tests: Performed to measure levels of biomarkers such as B-type natriuretic peptide (BNP) that indicate heart failure.
- Cardiac MR: Used to image the structure of heart muscle tissue in more detail to see if there is damage or inflammation.
- Genetic Tests: If there is a family history of cardiomyopathy, performed to identify gene mutations that may cause the disease.
How is Dilated Cardiomyopathy Treated?
Treatment of dilated cardiomyopathy aims to manage symptoms, slow progression, and prevent complications rather than completely eliminating the disease. Treatment usually consists of medications and lifestyle changes.
Medication Treatment:
- ACE Inhibitors and ARBs: Reduce the heart’s workload, lower blood pressure, and slow disease progression. ARBs (Angiotensin Receptor Blockers) are used as alternatives when ACE inhibitors are not tolerated.
- Beta Blockers: Help improve heart function by slowing heart rate and reducing the force of contractions.
- Diuretics: Relieve symptoms such as shortness of breath and swelling by eliminating excess fluid from the body.
- Blood Thinners: Used to reduce clot formation and stroke risk in patients with heart failure.
- SGLT2 Inhibitors: Newer medications that have been shown to improve outcomes in heart failure patients.
Lifestyle Changes:
- Salt and Fluid Restriction: Reducing salt intake prevents fluid accumulation in the body, reducing the heart’s workload.
- Regular Exercise: Light and regular exercise at the level recommended by your doctor can strengthen the heart muscle.
- Avoiding Alcohol and Cigarettes: Alcohol can be a direct cause of some dilated cardiomyopathy cases. These substances directly damage the heart muscle and accelerate disease progression.
- Stress Management: Stress can increase heart load, so stress-reducing techniques like yoga and meditation can be beneficial.
- Healthy Nutrition: A diet rich in healthy fats, fruits, and vegetables is recommended.
Device Treatment:
- Cardioverter-Defibrillator (ICD): When the patient’s heart rhythm is dangerously disturbed, it delivers a shock to restore the heart’s normal rhythm and reduces the risk of sudden death.
- Cardiac Resynchronization Therapy (CRT): Ensures that the heart’s two lower chambers contract simultaneously to improve the heart’s pumping function.
- Left Ventricular Assist Device (LVAD): In DCM patients with advanced heart failure, this is a mechanical pump placed in the body to support the heart’s pumping function. This device can serve as a bridge in patients waiting for heart transplant or provide long-term support in patients who are not transplant candidates.
Surgical Treatment:
- Mitral Valve Repair: Valve repair can be performed in DCMP patients with severe mitral valve insufficiency. This procedure can be performed with open heart surgery or less invasive (interventional) methods.
- In advanced stage dilated cardiomyopathy patients, heart transplant may be necessary when other treatments do not respond.
What are the Complications of Dilated Cardiomyopathy?
Dilated cardiomyopathy can lead to serious complications when not treated or controlled.
- Heart Failure: This is a natural consequence of the disease and is the condition where the heart cannot pump enough blood to the body.
- Arrhythmias: Structural changes in the heart muscle can disrupt the heart’s electrical system, causing fatal rhythm disorders (such as ventricular fibrillation).
- Clotting Problems: Slow movement of blood inside the heart can cause clot formation. These clots can go to the brain causing stroke or to other organs causing blockages.
- Sudden Cardiac Death: There is a risk of sudden cardiac arrest and death due to rhythm disorders.
When Should You See a Doctor?
When you notice dilated cardiomyopathy symptoms or if there is a history of this disease in your family, you should see a doctor without delay. Especially the following symptoms require urgent medical evaluation:
- Sudden onset or worsening shortness of breath
- Chest pain
- Fainting or severe dizziness sensation
- Obvious swelling in legs or abdomen
Reference: Dilated cardiomyopathy
