Cardiac Sciences

Dilated Cardiomyopathy: Causes, Warning Signs, and Diagnosis

admin Sep 20, 2024

Introduction

Dilated cardiomyopathy (DCM) is also known as congestive cardiomyopathy. It is a serious condition of the heart muscle characterised by the dilation of one or both the ventricles, causing heart’s enlargement and impaired contractility. DCM is more commonly observed in men compared to women. The condition can lead to the thinning of tissue, causing the heart to exert less force and the blood to remain in the heart. Understanding the causes, warning signs, and diagnosis of DCM is crucial for early treatment and improved outcomes.

Understanding the problem: A dilated heart

“Dilated” refers to the enlargement of the heart’s chambers, particularly the left ventricle, the main pumping chamber. In DCM, the heart muscle weakens and stretches, reducing its efficiency to pump the blood adequately and fulfil the body’s demand for blood supply. This can result in:

Backflow of blood: As the heart struggles to pump, the blood can back up into the lungs, causing shortness of breath and fluid buildup.
Reduced blood flow: A weakened heart cannot deliver enough oxygenated blood to the body, leading to fatigue, weakness, and even organ damage.

Causes

In most cases, the cause of DCM is referred to as idiopathic, which means no family history or genetic link. However, studies have identified certain causes, including:

Genetic predisposition
Gene mutations, especially in genes encoding cytoskeletal, nuclear membrane, and contractile proteins
Presence of infectious myocarditis
Ischemic diseases and hypertension
Drug interaction, especially the use of drugs called anthracyclines
Alcohol abuse
Viral infections
Autoimmune disease

Recognising the warning signs

DCM often develops gradually and can go undetected for a long time. It is important to be aware of the common warning signs, including:

Shortness of breath, especially with exertion
Fatigue and weakness
Swelling in the legs, ankles, or feet
Rapid or irregular heartbeat
Chest pain
Dizziness or fainting
Coughing, especially at night

It is important to seek immediate medical attention if you are experiencing any of these symptoms. Early diagnosis and treatment are necessary for improving outcomes.

Diagnosis

Diagnosing DCM involves a combination of assessments:

Medical history and physical exam: Your treating doctor will enquire about your medical history, family history, and symptoms.
Electrocardiogram (ECG): This test measures electrical activity in the heart and can detect abnormalities and reveal the presence of atrial fibrillation.
Echocardiogram: This ultrasound imaging test helps visualise the heart’s structure and function, showing the extent of dilation and pumping capacity.
Chest X-ray: This can reveal fluid buildups in the lungs, called pulmonary effusions, which are a sign of heart failure and show the presence of venous congestion.
Blood tests: Blood tests can identify markers of heart damage and rule out other conditions.
Cardiac catheterisation: This procedure encompasses inserting a thin, long tube into a blood vessel to visualise the coronary arteries and assess blood flow.
Genetic testing and counselling: A genetic specialist can advise whether the individual and their family members need to undergo genetic testing to look for genetic changes or mutations that cause DCM.

In individuals without a known history of coronary artery disease, the doctor may suggest coronary angiography to get accurate images of the blood vessels and examine for hidden heart problems that might be causing DCM.

Treatment and management

Managing DCM requires a multidisciplinary approach. Although there is no cure for the condition, a team of healthcare professionals, comprising cardiologists, electrophysiologists, dieticians, nurses, and health counsellors, work together to manage the condition. The treatment might include:

Medications: Drugs such as ACE inhibitors, beta-blockers, and diuretics can help alleviate and manage symptoms associated with DCM.
Lifestyle changes: One can adapt to better heart health by cutting down alcohol consumption, restricting consumption of salt and water as suggested by the doctor, and ensuring the achievement of the desired weight and regular exercise.
Heart transplantation: In severe cases, such as end-stage heart failure, a patient may need to undergo a heart transplant.
Implantable devices: In certain instances, a pacemaker or a defibrillator may be implanted to regulate heart rhythm.

Conclusion

DCM is a severe disease, but timely diagnosis and the beginning of the therapy considerably increase the quality of life of the patient. Regular heart health checkups, especially if you have a family history of DCM, can prove crucial to identifying the early signs of DCM. In the case of any signs relating to the disease, it is advisable to seek an opinion from the doctor.

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