Dilated Cardiomyopathy

sweetcindy · #1 (**permalink**) 04-16-2001, 03:39 PM

Ok, this is the best definition I can find for my heart condition. Mine is really called ideopathic dilated cardiomyopathy (ideopathic meaning from an unknown cause) although the best guess is the flu virus attacked my heart.
I was diagnosed in Jan 2000 with CHF from the cardiomyopathy. I have passed the point of time (usually 6 months to a year) where my heart could have gone back to normal. It was unlikely because my EF is very low (20%) and I will need a transpant during my lifetime...I am just trying to survive as long as possible with my own heart.
Anyhow, for those of you who are interested, here is the definition.

Cindy

Dilated (Congestive) Cardiomyopathy
By far the most common type of nonischemic cardiomyopathy, the dilated (stretched) form occurs when disease-affected muscle fibers lead to enlargement, or dilation, of one or more chambers of the heart. This weakens the heart's pumping ability. The heart tries to cope with the pumping limitation by further enlarging and stretching--a process known as "compensation."
Dilated cardiomyopathy occurs most often in middle-aged people and more often in men than women. However, the disease has been diagnosed in people of all ages, including children.

In most cases, the disease is idiopathic--a specific cause for the damage is never identified.

But some factors have been linked to the disease's occurrence. For instance, alcohol has a direct suppressant effect on the heart. Dilated cardiomyopathy can be caused by chronic, excessive consumption of alcohol, particularly in combination with dietary deficiencies. Also, dilated cardiomyopathy occasionally occurs as a complication of pregnancy and childbirth. Other factors are: various infections, mostly viral, which lead to an inflammation of the heart muscle (myocarditis); toxins (such as cobalt, once used in beers, for instance); and, rarely, heredity.

Some drugs, used to treat a different medical condition, also can damage the heart and produce dilated cardiomyopathy. Such drugs include doxorubicin and daunorubicin, both used to treat cancer.

Whatever the cause, the clinical and pathological manifestations of dilated cardiomyopathy are usually the same.

Symptoms

Dilated cardiomyopathy can be present for several years without causing significant symptoms. With time, however, the enlarged heart gradually weakens.

This condition is commonly called "heart failure," and it is the hallmark of dilated cardiomyopathy. Typical signs and symptoms of heart failure include: fatigue; weakness; shortness of breath, sometimes severe and accompanied by a cough, particularly with exertion or when lying down; and swelling of the legs and feet, resulting from fluid accumulation that may also affect the lungs (congestion) and other parts of the body. It also produces abnormal weight gain. (The cough and congestion mimic and, therefore, can be misdiagnosed as pneumonia or acute bronchitis. Also, heart failure is often from heart disease other than cardiomyopathy.)

Because of the congestion, some physicians use the older term "congestive cardiomyopathy" to refer to dilated cardiomyopathy. In advanced stages of the disease, the congestion may cause pain in the chest or abdomen.

In advanced stages, some patients develop irregular heartbeats, which can be serious and even life threatening.

Diagnosis

Once symptoms appear, the condition may be tentatively diagnosed based on a physical examination and a patient's medical history. More often, though, further examination is needed to differentiate dilated cardiomyopathy from other causes of heart failure.

A firm diagnosis typically requires a chest x ray to show whether the heart is enlarged, an electrocardiogram to reveal any abnormal electrical activity of the heart, and an echocardiogram, which uses sound waves to produce pictures of the heart.

Other, more specific tests may also be needed. These include:

A radionuclide ventriculogram. This involves injecting low-dose radioactive material (usually equal to that in a set of chest x rays) into a vein, through which it flows to the heart. Pictures are generated by a special camera to show how well the heart is functioning.

A cardiac catheterization. In this procedure, a thin plastic tube is inserted through a blood vessel until it reaches the heart. A dye is injected and x rays taken to assess the heart's structure and function.
Treatment
Since dilated cardiomyopathy is hard to diagnose early, it is rarely treated in its beginning stage.

The goal of treatment is to relieve any complicating factor, if known, control the symptoms, and stop the disease's progression. However, no cure now exists.

Therapy begins with the elimination of obvious risk factors, such as alcohol consumption. Weight loss and dietary changes, especially salt restriction, may also be advised.

Drugs used to treat the condition include:

Diuretics, which reduce excess fluid in the body;

Vasodilators, such as angiotensin-converting enzyme (ACE) inhibitors, which relax blood vessels, helping to lower blood pressure and reducing the effort needed by the heart to pump blood through the body;

Digitalis, which helps to improve pumping action and regulate heartbeat; and,

Calcium blockers or beta blockers, which may be used in some patients to help regulate heartbeat and to alter the work of the heart muscle.
Also, patients with irregular heartbeats may be put on any of various drugs to control the rhythm.
In critical cases where the condition is advanced and the patient does not sufficiently respond to other treatments, a heart transplantation may be needed. The patient's heart is replaced with a donor heart. Most heart transplant recipients are under age 60 and in good health other than their diseased heart.

Course of the disease

As the heart enlarges, it steadily decreases its efficiency in pumping blood and the amount of blood it can pump. As a result, some patients cannot perform even simple physical activities.

However, the disease also may remain fairly stable for years, especially with treatment and regular evaluation by a physician.

Unfortunately, by the time it is diagnosed, the disease often has reached an advanced stage and heart failure has occurred. Consequently, about 50 percent of patients with dilated cardiomyopathy live 5 years once heart failure is diagnosed; about 25 percent live 10 years after such a diagnosis.

Typically, patients die from a continued decline in heart muscle strength, but some die suddenly of irregular heartbeats.

For patients with advanced disease, heart transplantation greatly improves survival: 75 percent of patients live 5 years after a transplantation. However, in the United States, the scarcity of donor hearts limits the number of transplantations to about 2,000 persons a year. Those who qualify for heart transplantation often have to wait months, or even years, for a suitable donor heart. Some patients with dilated cardiomyopathy die awaiting a transplant but, according to recent studies, others improve enough from aggressive medical treatment to be taken off the waiting list.

Also, some critically ill cardiomyopathy patients with declining heart function use a small, implanted mechanical pump as a bridge to transplantation. Called left ventricular assist devices (LVADs), these pumps take over part or virtually all of the heart's blood pumping activity. The devices provided only temporary assistance and are not now used as substitutes for heart transplantation.