What Is Dilated Cardiomyopathy?

Overview 

Dilated cardiomyopathy (DCM) is a condition that affects the heart muscle, causing it to stretch and become thin. The left ventricle, the main pumping chamber of the heart, is where the disease typically begins. DCM can eventually have an impact on some people's right ventricles as well. As the heart muscle dilates, the inside of the chamber enlarges. Consequently, the heart muscle cannot adequately contract and cannot pump blood as effectively as it should, which can cause signs and symptoms like fatigue, shortness of breath, and swelling in the legs and ankles. This might result in heart failure as the heart becomes weaker with time. It can develop for unknown reasons, known as idiopathic dilated cardiomyopathy. Genetic mutations, viral infections, alcohol abuse, and certain medications are only a few of the other causes of dilated cardiomyopathy. Although not rare, DCM is not very common. It often affects people between the ages of 20 and 60, with people assigned male at birth being affected more frequently than people assigned female at birth. Treatment may include medication, lifestyle changes, and in some cases, surgery or a heart transplant. Regular monitoring and follow-up with a healthcare provider are important for people with dilated cardiomyopathy to manage their condition and prevent complications.

Causes of dilated cardiomyopathy

 The causes of DCM can vary, but some common causes include:

• Genetics: DCM can be caused by genetic mutations, which can be inherited from a parent 
• Nutritional deficiencies: A lack of certain vitamins and minerals can also lead to the development of DCM
• Pregnancy: Heart muscle disease might occasionally arise as a consequence, but most of them recover over time
• Medical Conditions: These include problems with the heart valves, uncontrolled high blood pressure, untreated heart disease, and diseases of the blood vessels or tissue within the body
• Alcohol abuse: This is sometimes referred to as alcoholic cardiomyopathy
• Certain medications, Such as chemotherapy drugs, can cause damage to the heart muscle and lead to DCM
• Infection: Viruses, bacteria, protozoa, helminths, and fungi are just a few of the pathogens that can lead to inflammatory dilated cardiomyopathy (DCM)¹
• Autoimmune disorders: Conditions such as lupus and rheumatoid arthritis, which cause the immune system to attack the body's tissues, can sometimes lead to DCM²

Signs and symptoms of dilated cardiomyopathy

Depending on the extent of heart damage, dilated cardiomyopathy (DCM) can result in a variety of signs and symptoms, varying in severity. Some common signs and symptoms of DCM include:

• Shortness of breath
• Fatigue
• Swelling
• Palpitations: Fluttering, thudding or pounding in your neck or chest.
• Chest pain

Management and treatment for dilated cardiomyopathy

DCM cannot be cured. However, most of the symptoms can be managed with a combination of medications, lifestyle modifications, and, in some cases, surgery, which allows one to live a normal life. The first approach is to address any underlying issues, such as limiting exposure to toxins like alcohol, managing autoimmune diseases or infections, as well as taking into consideration of possible nutritional factors. Here are some common approaches to managing DCM:

Medications: 

Some medications that your healthcare provider may prescribe include: 

• Blood pressure medications: ACE inhibitors, ARBs, or beta blockers to lower blood pressure and reduce the strain on the heart
• Diuretics (water pills), to remove excess fluid and salt from the body and prevent fluid buildup in the lungs and other organs
• Anticoagulants to prevent blood clots from forming
• Digoxin, beta-blockers, calcium channel blockers to slow down your heart rate

Lifestyle changes 

Making lifestyle adjustments by maintaining a healthy diet, avoiding foods containing large amounts of sugar, salt and trans fat, avoiding alcohol and smoking, including physical activity, etc

Device implantation or surgical procedures

A range of surgical and non-surgical procedures can be used to treat cardiomyopathy:

• Pacemaker to regulate the heart's rhythm and improve blood flow
• Implantable cardioverter defibrillator (ICD): The purpose is to continuously monitor the rhythm of your heart and, if necessary, shock it electrically to return it to a normal rhythm
• Left ventricular assist device (LVAD) to help the heart pump blood more effectively, either as a bridge to a transplant or as a long-term treatment option
• Heart transplant to replace a severely damaged heart with a healthy donor heart
• Alcohol septal ablation (nonsurgical procedure): Ethanol (a type of alcohol) is injected through a tube into the small artery that supplies blood to the area of heart muscle thickened by hypertrophic cardiomyopathy. The alcohol causes these cells to die, resulting in the shrinkage of the thickened tissue to a more normal size.

Diagnosis of dilated cardiomyopathy

The diagnosis of DCM usually involves a combination of medical history, physical examination, and diagnostic testing. 

• Medical history: The healthcare provider will ask about symptoms, family history of heart disease, and any other relevant cardiac conditions
• Physical examination: The healthcare provider will listen to the heart for abnormal heart sounds, check for signs of fluid buildup in the lungs or abdomen, and check for signs of other medical conditions 
• Diagnostic testing: Several tests may be performed to confirm the diagnosis of DCM, including an echocardiogram, electrocardiogram (ECG), X-ray of the chest, exercise tests, etc

You might undergo additional tests, such as:

• Cardiac stress testing to look for heart-related blood flow issues
• Blood testing to look for a variety of illnesses, including autoimmune disorders and infectious diseases
• Cardiac MRI to look into the coronary arteries and heart structure in more detail
• Cardiac biopsy: To examine the heart more precisely, a small sample of the heart tissue may be taken and studied under a microscope
• Coronary angiography, or cardiac catheterisation, is a procedure that looks at the coronary arteries
• Genetic testing

Risk factor

Risk factors for DCM include nutritional deficiencies, autoimmune diseases, pregnancy, obesity, viral infections, long-term alcohol or drug abuse, genetic mutations, family history, etc. The probability of having DCM is increased by these factors, which can harm the heart muscle. 

Complications

Dilated cardiomyopathy (DCM) can result in several complications, such as:

• Heart failure
• Arrhythmias: DCM may result in abnormal heart rhythms, which may be life-threatening.
• Blood clots
• Sudden cardiac arrest
• Angina- It refers to pain or discomfort in the arms, neck, or chest

These complications can cause a range of symptoms and may require medical treatment to manage.

FAQs

How can I prevent dilated cardiomyopathy?

You cannot prevent DCM, especially if there is a family history. You can lower your risk by making lifestyle changes, treating underlying health issues that can lead to DCM, scheduling regular check-ups with your healthcare provider if there is a family history, etc. 

How common is dilated cardiomyopathy?

DCM is uncommon but not rare. 1 in every 250 people in the UK are affected. 

When should I see a doctor? 

If there is a family history or if you suspect that you have any underlying health issues that can lead to DCM or if you experience any symptoms of DCM like palpitations, chest pain, shortness of breath etc visit your healthcare provider immediately. 

Summary

Dilated cardiomyopathy is a condition that affects the heart muscle, causing it to stretch and become thin. This occurs in the left ventricle, and thinner, weaker walls here mean the heart cannot pump blood effectively to the other parts of the body.  DCM may be caused due to genetics or heart attack damage, but the cause is often unknown. In advanced stages, this condition can lead to complications that include heart failure or other cardiovascular issues. If you have a family history, an underlying health condition that can potentially lead to DCM or experience any symptoms of DCM, visit your healthcare provider immediately.