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Topic Overview

What is dilated cardiomyopathy?

Dilated cardiomyopathy is a serious condition that weakens your heart muscle and causes it to stretch, or dilate. When your heart muscle is weak, it can't pump out blood as well as it should, so more blood stays in your heart after each heartbeat. As more blood fills and stays in the heart, the heart muscle stretches even more and gets even weaker.

Most of the time, this leads to heart failure. Heart failure does not mean that your heart stops pumping. It means that your heart can't pump enough blood to meet your body's needs.

What causes dilated cardiomyopathy?

The most common type of dilated cardiomyopathy develops after a heart attack has damaged the heart muscle. But it can also be caused by many diseases or problems that may or may not be related to your heart. Sometimes the cause is not known.

Some of the things that can lead to dilated cardiomyopathy include:

• Coronary artery disease and heart attack.
• High blood pressure, which can put stress on the heart walls.
• Heart valve diseases, including aortic valve regurgitation and mitral valve regurgitation.
• Myocarditis, which is inflammation of the heart muscle. It is caused by a virus or an immune system problem.
• Drinking too much alcohol, using certain illegal drugs such as cocaine, or taking certain medicines such as chemotherapy.
• Being exposed to toxic metals, such as lead or mercury.
• Being pregnant. In rare cases, dilated cardiomyopathy develops toward the end of pregnancy or during the first 6 months after a woman gives birth. Experts don't know why this happens.

What are the symptoms?

You may not have any symptoms at first. Or you may have mild symptoms, such as feeling very tired or weak.

If your heart gets weaker, you will develop heart failure. When this happens, you will feel other symptoms, including:

• Shortness of breath, especially with activity.
• Tiredness.
• Trouble breathing when you lie down.
• Swelling in your legs.
• Chest pain.

You may get these symptoms slowly, over months or years. Or you may get them suddenly, such as after pregnancy or an illness caused by a virus.

Heart failure that suddenly gets worse is an emergency. Get medical help right away if:

• You have severe trouble breathing.
• You cough up pink, foamy mucus.
• You have a new irregular or rapid heartbeat.

When you have heart failure, keeping track of your symptoms every day is important. Call your doctor if:

• You have a sudden weight gain such as 3 lb (1.4 kg) or more in 2 to 3 days.
• Your ability to exercise changes.
• You have any change in your symptoms.

How is dilated cardiomyopathy diagnosed?

Your doctor will ask questions about your symptoms and past health. He or she will want to know about recent illnesses and about heart disease in your family. Your doctor will listen to your heart and lungs and check your legs for fluid buildup.

You may also have other tests, including:

• An electrocardiogram, also known as an ECG or EKG.
• A chest X-ray.
• An echocardiogram.
• Coronary catheterization (angiogram).
• Routine blood tests.

In some cases, a doctor may want to look at a small sample of heart tissue, called a biopsy, to make a definite diagnosis.

How is it treated?

Treatment for dilated cardiomyopathy focuses on relieving your symptoms, improving heart function, and helping you live longer.

You will probably need to take several medicines to treat heart failure caused by dilated cardiomyopathy. It is very important to take your medicines exactly as your doctor tells you to and to keep taking them. If you don't, your heart failure could get worse.

Your doctor may suggest a mechanical device to help your heart pump blood or to prevent life-threatening irregular heart rhythms. Such devices include a pacemaker for heart failure (also called cardiac resynchronization therapy or CRT), an implantable cardioverter-defibrillator (ICD), or a combination pacemaker and ICD. If your condition is very bad, a heart transplant may be an option.

Self-care is an important part of your treatment. Self-care includes the things you can do every day to feel better, stay healthy, and avoid the hospital.

• Take your medicines as prescribed. This gives them the best chance of helping you. Medicines for heart failure include:
  • Angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs). These make it easier for blood to flow.
  • Diuretics. These help remove excess fluid from the body.
  • Beta-blockers. These slow the heart rate and can help the heart fill with blood more completely.
• Live a healthy lifestyle. It can help slow down heart failure. Limit salt, try to get regular exercise, and don't smoke.
• Watch for signs you're getting worse. Weighing yourself every day is a good way to do this.
• Find out what your triggers are, and learn to avoid them. Triggers are things that make your heart failure worse, often suddenly. A trigger may be eating too much salt, missing a dose of your medicine, or exercising too hard.

What can you expect with dilated cardiomyopathy?

Most of the time, dilated cardiomyopathy leads to heart failure. Heart failure usually gets worse over time, but treatment can slow the disease and help you feel better and live longer. In more and more cases, the problem is being found earlier, when it can be better managed.

Some people develop other problems, including:

• Stroke.
• Heart attack.
• Sudden cardiac death, which means the heart suddenly stops working. This may be more likely to happen to people who have serious rhythm problems (arrhythmias) in one of the lower heart chambers (ventricles).

If a woman gets dilated cardiomyopathy from pregnancy, she should not get pregnant again. This is true even if her heart problem gets better.

If your disease is getting worse, you may want to think about making end-of-life decisions. It can be comforting to know that you will get the type of care you want.