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Dilated cardiomyopathy

Cardiomyopathy - dilated; Primary cardiomyopathy; Diabetic cardiomyopathy; Idiopathic cardiomyopathy; Alcoholic cardiomyopathy

 

Cardiomyopathy is disease in which the heart muscle becomes weakened, stretched, or has another structural problem.

Dilated cardiomyopathy is a condition in which the heart muscle becomes weakened and enlarged. As a result, the heart cannot pump enough blood to the rest of the body.

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

Causes

 

The most common causes of dilated cardiomyopathy are:

  • Heart disease caused by a narrowings or blockages of the coronary arteries
  • Poorly controlled high blood pressure

There are many other causes of dilated cardiomyopathy, including:

  • Alcohol or cocaine abuse
  • Diabetes, thyroid disease, or hepatitis
  • Medicines that can be toxic to the heart, such as drugs used to treat cancer
  • Abnormal heart rhythms in which the heart beats very fast for a long period of time
  • Autoimmune illnesses
  • Conditions that run in families
  • Infections that involve the heart muscle
  • Heart valves that are either too narrow or too leaky
  • During the last month of pregnancy, or within 5 months after the baby is born.
  • Exposure to heavy metals such as lead, arsenic, cobalt, or mercury

This condition can affect anyone at any age. However, it is most common in adult men.

 

Symptoms

 

Symptoms of heart failure are most common. They most often develop slowly over time. However, sometimes symptoms start very suddenly and are severe.

Common symptoms are:

  • Chest pain or pressure (more likely with exercise)
  • Cough
  • Fatigue, weakness, faintness
  • Irregular or rapid pulse
  • Loss of appetite
  • Shortness of breath with activity or after lying down (or being asleep) for a while
  • Swelling of feet and ankles

 

Exams and Tests

 

During the exam, the health care provider may find:

  • The heart is enlarged.
  • Lung crackles (a sign of fluid buildup), heart murmur, or other abnormal sounds.
  • The liver is possibly enlarged.
  • Neck veins may be bulging.

A number of laboratory tests may be done to determine the cause:

  • Antinuclear antibody (ANA), erythrocyte sedimentation rate (ESR), and other tests to diagnose autoimmune illnesses
  • Antibody test to identify infections such as Lyme disease and HIV
  • Iron tests of the blood
  • Serum TSH and T4 test to identify thyroid problems
  • Tests for amyloidosis

Heart enlargement or other problems with the structure and function of the heart (such as weak squeezing) may show up on these tests. They may also help diagnose the exact cause of the problem:

  • Echocardiogram (ultrasound of the heart)
  • Cardiac stress tests
  • Chest x-ray
  • Coronary angiogram to look at blood flow to the heart
  • CT scan of the heart
  • MRI of the heart
  • Nuclear heart scan (MUGA, RNV)

Heart biopsy, in which a small piece of heart muscle is removed, may be needed depending on the cause. However, this is rarely done.

 

Treatment

 

Things you can do at home to take care of your condition include:

  • Know your body, and watch for symptoms that your heart failure is getting worse.
  • Watch for changes in your symptoms, heart rate, pulse, blood pressure, and weight.
  • Limit how much you drink and how much salt (sodium) you get in your diet.

Most people who have heart failure need to take medicines. Some medicines treat your symptoms. Others may help prevent your heart failure from becoming worse, or may prevent other heart problems.

Procedures and surgeries you may need include:

  • A pacemaker to help treat slow heart rates or help your heartbeat stay in sync
  • A defibrillator that recognizes life-threatening heart rhythms and sends an electrical pulse to stop them
  • Heart bypass (CABG) surgery or angioplasty to improve blood flow to the damaged or weakened heart muscle
  • Valve replacement or repair

For advanced cardiomyopathy:

  • A heart transplant may be recommended if standard treatments have not worked and heart failure symptoms are very severe.
  • Placement of a left ventricular assist device or artificial heart may be considered.

Chronic heart failure becomes worse over time. Many people who have heart failure will die from the condition. Thinking about the type of care you may want at the end of life and discussing these issues with loved ones and your health care provider is important.

 

Outlook (Prognosis)

 

Heart failure is most often a chronic illness, which may get worse over time. Some people develop severe heart failure, in which medicines, other treatments, and surgery no longer help. Many people are at risk for deadly heart rhythms, and may need medicines or a defibrillator.

 

When to Contact a Medical Professional

 

Call your provider if you have symptoms of cardiomyopathy.

Get emergency medical help right away if you have chest pain, palpitations or fainting.

 

 

References

Falk RH, Hershberger RE. The dilated, restrictive, and infiltrative cardiomyopathies In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 65.

Mckenna WJ, Elliott P. Diseases of the myocardium and endocardium. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 60.

 
  • Cardiomyopathy overview

    Cardiomyopathy overview

    Animation

  •  

    Cardiomyopathy overview - Animation

    Types, causes, symptoms, health risks, and treatment of cardiomyopathy.

  • Heart, section through the middle

    Heart, section through the middle - illustration

    The interior of the heart is composed of valves, chambers, and associated vessels.

    Heart, section through the middle

    illustration

  • Heart, front view

    Heart, front view - illustration

    The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.

    Heart, front view

    illustration

  • Dilated cardiomyopathy

    Dilated cardiomyopathy - illustration

    Dilated cardiomyopathy involves enlargement of the heart muscle and is the most common type of cardiomyopathy. The heart muscle is weakened and cannot pump blood efficiently. Decreased heart function affects the lungs, liver, and other body systems.

    Dilated cardiomyopathy

    illustration

  • Alcoholic cardiomyopathy

    Alcoholic cardiomyopathy - illustration

    Excessive use of alcohol has a direct toxic effect on the heart muscle cells. The heart muscle becomes weakened and cannot pump blood efficiently. The lack of blood flow affects all parts of the body, resulting in damage to multiple tissues and organ systems. Alcohol may also directly damage the liver.

    Alcoholic cardiomyopathy

    illustration

  • Cardiomyopathy overview

    Animation

  •  

    Cardiomyopathy overview - Animation

    Types, causes, symptoms, health risks, and treatment of cardiomyopathy.

  • Heart, section through the middle

    Heart, section through the middle - illustration

    The interior of the heart is composed of valves, chambers, and associated vessels.

    Heart, section through the middle

    illustration

  • Heart, front view

    Heart, front view - illustration

    The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.

    Heart, front view

    illustration

  • Dilated cardiomyopathy

    Dilated cardiomyopathy - illustration

    Dilated cardiomyopathy involves enlargement of the heart muscle and is the most common type of cardiomyopathy. The heart muscle is weakened and cannot pump blood efficiently. Decreased heart function affects the lungs, liver, and other body systems.

    Dilated cardiomyopathy

    illustration

  • Alcoholic cardiomyopathy

    Alcoholic cardiomyopathy - illustration

    Excessive use of alcohol has a direct toxic effect on the heart muscle cells. The heart muscle becomes weakened and cannot pump blood efficiently. The lack of blood flow affects all parts of the body, resulting in damage to multiple tissues and organ systems. Alcohol may also directly damage the liver.

    Alcoholic cardiomyopathy

    illustration

A Closer Look

 

    Self Care

     

      Tests for Dilated cardiomyopathy

       

       

      Review Date: 2/24/2016

      Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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