Dilated cardiomyopathy
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
Cardiomyopathy - dilatedCauses
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. The most common causes of dilated cardiomyopathy in children are idiopathic, myocarditis, coronary disease, and some infections.
It can affect anyone of any age, although it is most common in adult men.
Risk factors in adults include obesity, cocaine use, a personal or family history of cardiac disorders (such as myocarditis), and alcoholism.
Symptoms
- Heart failure
- Shock
- Swelling of feet and ankles (in adults)
- Swelling of the abdomen (in adults)
- Pronounced neck veins
- Loss of appetite
- Shortness of breath, especially with activity
- Shortness of breath occurring after lying down for awhile ,or in infants while feeding
- 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 (in adults)
- Failure to thrive (in children)
- Alström syndrome
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.
Children will have poor growth, pale skin, difficulty feeding, and weak pulses in the legs and arms.
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 or MRI of the heart
- Cardiac catheterization and coronary angiography
- Nuclear heart scan (MUGA, RNV)
An ECG may show conduction disturbances or arrhythmias, including tachycardia, 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 or prevent any severe arrhythmias (abnormal heart rhythms). A biventricular pacemaker with defibrillation capabilities is available.
A low-salt diet may be prescribed for adults, 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 (in adults).
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 be corrected only if the underlying disease can be cured.
In children, about one-third recover completely, one-third recover but continue to have some heart problems, and one-third die.
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.
Hare JM. The dilated, restrictive, and infiltrative cardiomyopathies. Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. St. Louis, Mo: WB Saunders; 2007: chap 64.
Reviewed By: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.; and Mark A Fogel, MD, FACC, FAAP, Associate Professor of Pediatrics and Radiology, Director of Cardiac MR, The Children's Hospital of Philadelphia.
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