Dilated Cardiomyopathy

What is dilated cardiomyopathy?

Dilated cardiomyopathy (kar-d-o-mi-AH-puh-thee) is also called "DCM" or congestive (kun-JES-tiv) cardiomyopathy. DCM is a disease of the heart muscle that causes parts of your heart to get larger.

How does the heart normally work?

The heart has 4 chambers, or rooms. The two upper chambers are called atria (A-tree-uh). The two lower chambers are called ventricles (VEN-trik-ulls). Blood vessels bring blood from your body to the right atrium in your heart. The blood is pumped into the right ventricle where it is pumped into the lungs to get oxygen. The oxygen-rich blood goes into the left atrium and is pumped into the left ventricle. The left ventricle pumps the blood out to the body where the oxygen can be used.

How does the heart work with DCM?

Dilated cardiomyopathy is when disease affects your heart muscles, causing the chambers of your heart to dilate (enlarge). This makes it harder for your heart to pump. Your heart tries to adjust to the problem by getting even larger. Even though your heart gets larger, it still cannot pump enough blood and oxygen out to the body.

Causes:

DCM may happen for no known cause. This is called idiopathic (IH-d-o-path-ik) DCM. Many illnesses and health problems may cause DCM. Following are possible causes of DCM:

• Viral infections.
  
  
• Nutritional problems like anorexia.
  
  
• Other heart problems, like coronary artery disease or problems with your heart valves.
  
  
• Genetic disease.
  
  
• Alcoholism.

Signs and Symptoms:

• Early: You may not have any symptoms for several years.
  
  
• With time: The symptoms may develop slowly over weeks or months as your heart gets larger and weaker. You may have one or more of the following signs or symptoms:
  
  
  • Crackling sound when caregivers listen to your lungs from the extra fluid in your lungs.
    
    
  • Dizziness or fainting.
    
    
  • Fatigue (tiredness).
    
    
  • Hands, arms, feet, and legs feel cold to touch.
    
    
  • Heart murmur (extra sound) when caregivers listen to your heartbeat.
    
    
  • Lips, fingernails, and toenails turn blue.
    
    
  • Shortness of breath when you lie down.
    
    
  • Shortness of breath while you are resting and with mild activity like walking from room to room.
    
    
  • Sweating.
    
    
  • Swollen legs, feet, and abdomen (belly) and abnormal weight gain from extra fluid in your body.
    
    
  • Your liver and spleen get larger.
  
  
• Late: In advanced stages of dilated cardiomyopathy, you may have one or more of the following signs or symptoms:
  
  
  • Chest pain.
    
    
  • Heart beats too fast or not regular.
    
    
  • Pain in your abdomen.
    
    
  • Veins in your neck stick out.

Tests:

Many tests will be done to learn if your heart disease is getting worse. You may have one or more of the following tests. These tests may be repeated as caregivers continue to treat your disease over time. Ask your caregiver for CareNotes™ handout information if you want more information about the following tests:

• Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
  
  
• EKG: This test is done to learn if your heartbeat is normal. An EKG shows how the signal travels through the heart telling it to contract (pump). This test may be done to see if the signal takes too long to travel through the heart.
  
  
• Echocardiogram: This test is a type of ultrasound. Sound waves are used to show the structure, movement, and blood vessels of your heart.
  
  
• Radionuclide (ray-d-o-NU-klid) ventriculography (ven-trik-u-LAW-gruh-fee): This test uses dye to show how large the left ventricle has gotten. It can also show how much blood is pumped out of the heart with each contraction (heartbeat).
  
  
• Cardiac catheterization: This is a procedure done to find the cause of and treat a heart condition. A thin, bendable tube inserted into an arm, neck, or groin vein is moved into your heart. Your caregiver may use an x-ray to guide the tube to the right place. Dye (contrast) may be put into your vein so the pictures show up better on a monitor.
  
  
• CT Scan: This test is also called a "CAT" scan. A special x-ray machine uses a computer to take pictures of your heart. Before taking the pictures, you may be given dye through an IV in your vein. The dye helps the heart, valves, and blood vessels show up better in the pictures. People who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to this dye. Tell your caregiver if you are allergic to any of these.
  
  
• Heart biopsy (BI-op-c): Caregivers may want to do a biopsy of your heart muscle to help rule out (decide against) other heart problems. Your skin is first cleaned. Caregivers put numbing medicine into your skin to help decrease pain. During the test, a small piece of tissue is removed from your heart. The tissue is sent to the lab for tests. After the biopsy, stitches are used to close the wound. A bandage is put on the biopsy area.

Treatment Options:

DCM is hard for caregivers to diagnose early. You may be in later stages of DCM before you are diagnosed. The goal of treatment is to stop or prevent problems caused by DCM and keep the disease from getting worse.

• Activity: Exercise and other activities cause your body to need more oxygen, so the heart has to work harder. You may have to decrease your activities and you may not be allowed to do any hard exercise. You may even need to stay in bed for long periods of time.
  
  
• Healthy lifestyle: The most important thing you can do is to stop doing things that may cause DCM or make it worse. You should stop drinking alcohol, lose weight if needed, and eat a low fat, low salt diet.
  
  
• Implantable cardioverter (KAR-d-o-ver-ter) and defibrillator (d-FIB-rih-la-tur): An implantable cardioverter/defibrillator is a battery-operated device that finds and fixes bad heartbeats.
  
  
• Left ventricular assist device (LVAD): An LVAD is a small device put in your chest to do all or part of the pumping for your heart. You may need an LVAD if you are very sick but cannot have a heart transplant, yet.
  
  
• Medicine: You may need one or more of the following medicines to treat or prevent DCM or problems caused by DCM:
  
  
  • Antibiotics (an-ti-bi-AH-tiks). Antibiotics treat or prevent infections, such as infections of the heart valves. You may have to take antibiotics before having dental care or other types of procedures.
    
    
  • Blood thinning medicine and aspirin. Blood thinning medicine and aspirin treat or prevent blood clots.
    
    
  • Diuretics (di-u-RET-iks). Diuretics get rid of extra fluid in the body and lungs.
    
    
  • Heart medicine. Heart medicine treats irregular heartbeat and helps the heart beat more strongly.
    
    
  • Nutritional supplements. Nutritional supplements replace important vitamins and minerals your body may need.
    
    
  • Vasodilators (va-zo-DI-la-tors). Vasodilators open blood vessels so the heart does not have to pump against so much pressure.
  
  
• Surgery: You may need one of the following surgeries if you are in good physical condition other than having heart disease.
  
  
  • Mitral valve repair or replacement.
    
    
  • You may need a heart transplant if your heart is functioning poorly. Whether you can have a heart transplant depends on what is causing your DCM.

Support:

• DCM is a life-changing disease for you and your family. Accepting that you have heart disease is hard. You and those close to you may feel angry, sad, or frightened. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. Let them help you. Encourage those close to you to talk to your caregiver about how things are at home. Your caregiver can help your family better understand how to support a person with heart disease.
  
  
• You may also want to join a support group. This is a group of people who also have heart disease. Ask your caregiver for the names and numbers of support groups in your town. You can contact one of the following national organizations for more information.
  • American Heart Association
    7272 Greenville Avenue
    Dallas , TX 75231-4596
    Phone: 1- 800 - 242-8721
    Web Address: http://www.heart.org
    
  • National Asthma Education and Prevention Program
    National Heart, Lung and Blood Institute
    National Asthma Education and Prevention Program
    P.O. Box 30105
    Bethesda , MD 20824-0105
    Phone: 1- 301 - 592-8573
    Web Address: http://www.nhlbi.nih.gov/about/naepp/
    

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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