Heart Disease And Cardiomyopathy

Dilated cardiomyopathy

Dilated cardiomyopathy (DCM) is an abnormal  condition of dilatation of the heart muscles with weakened and enlarged  left ventricle,  the heart’s main pumping chamber. This leads to progressive decrease in ejection volume of the  blood pumped out  per heart beat. The left ventricle may fail to relax  preventing its filling  Other chambers of the heart may also be affected.

Symptoms of DCM

Many with DCM lead a normal life without showing any symptoms or only minor ones. With progressive worsening of the heart function  following symptoms are observed.

• Cardiac insufficiency (shortness of breath) due to reduction in ejection volume  of left ventricle upto 30%.
• Swelling of the legs and feet  weight gain , cough congestion due to fluid retention to compensate for the reduced cardiac out put
• Fatigue (feeling overly tired), inability to exercise, or even perform normal activities  due to reduced cardiac function
• Palpitations or fluttering in the chest due to abnormal heart rhythms (arrhythmia)
• Dizziness or lightheadedness  and  Fainting caused by irregular heart rhythms, abnormal responses of the blood vessels during exercise, These  symptoms may be without any apparent cause
• Pulmonary emboli (lungs), renal emboli (kidney) cerebral emboli or stroke (brain)  and peripheral emboli (limbs) due to blood clots as a result of  slow blood flow through the body
• Chest pain or  pressure (occurs usually with exercise or physical activity, but can also occur with rest or after meals).

Causes of DCM

Following are the causes of DCM  except  of   inherited (familial)DCM.  Causes of most cases of DCM  called idiopathic dilated cardiomyopathy or dilated nonischemic cardiomyopathy are unknown

• Severe coronary artery disease
• Alcoholism
• Thyroid disease
• Diabetes
• Viral bacterail, fungal infections
• Heart valve abnormalities
• Drugs that are toxic (or cause damage) to the heart  ( anthracyclins)

It can also occur in women after childbirth(postpartum cardiomyopathy).

Diagnosis of DCM

The diagnosis is based on  personal and familial medical history followed by physical examination and  specific tests like blood tests, electrocardiogram, chest X-ray, echocardiogram, exercise stress test, cardiac cathetirization, CT-scan and MRI.

Myocardial biopsy or heart biopsy where a tissue sample of  the heart is microscopically observed  is another test of detection rarely applied.

Relatives of those with familial DCM should be screened for DCM. by tests mentioned above  In addition a genetic testing may also be done to identify abnormal genes.

Treatment of DCM

Treatment is aimed at  correction of   the causes of DCM. Primary objective is to decrease  the heart size and also to decrease  thequantity of  substances in the bloodstream ,e.g., hormones, which enlarge the heart and aggarvate the symptoms. Several medications are available to the patient  to treat DCM. Physicians recommend  in addition  a variety of lifestyle changes to complement the drug therapy.

Drugs used to treat DCM

Beta-blockers and ACE inhibitors are administered to manage DCM even without onset of symptoms.  On appearance of symptoms or their aggravation, digoxin, diuretics, and aldosterone inhibitors are resorted to. If needed other medications are used by the physician, e.g., use of antiarrhythmics to control heart, use of blood thinners to prevent occurrence of blood clots. Your physician is the best judge for the choice of medication needed by you…

Lifestyle Changes

Diet:

On occurrence of symptoms like shortness of breath or fatigue, a restriction of intake of salt (sodium) to 2,000 to 3,000 mg per day is recommended. Continuation of the same regimen is recommended even on abatement of symptoms. One can adjust to the appropriate quantity by reading the sodium content on the labels of processed foods commonly used nowadays.

Exercice:

Non-competitive aerobic exercises are recommended while avoiding exercises like heavy weight lifting. DCM patients are advised to consult their physician for the appropriate exercise and its intensity.

Surgery for DCM:

One of the following surgery may be needed for severe DCM cases.

Cardiac resynchronization (CRT) by biventricular pacemaker:

Although under optimal therapy , if one still shows symptoms of heart failure and the ECG and Echocardiogram show specific characteristics putting a pace maker  helps to stimulate both right and left ventricles enabling the heart to contract with more force to improve the symptoms and increase physical endurance. Those with a heart block or bradychardia( slow heart rate) also benefit from  pace makers.

Implantable cardioverter defibrillators (ICD):

For patients at risk with life threatening arrythmias or sudden cardiac death ICD is recommended. It constantly monitors heart rhythms and changes  abnormal rhythms to the normal ones with appropriate supply of energy to the heart muscle.

Surgery   is adviced in valve diseases  in thin heart muscle after heart attack, in congenital malformations. Insertion of left ventricular assist device in case of advanced end stage heart failure.

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