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Dilated Cardiomyopathy

By

Tisha Suboc

, MD, Rush University

Last full review/revision Mar 2021| Content last modified Mar 2021
CLICK HERE FOR THE PROFESSONAL VERSION
Topic Resources

Dilated cardiomyopathy is a group of heart muscle disorders in which the ventricles (the two lower chambers of the heart) enlarge (dilate) but are not able to pump enough blood for the body’s needs, resulting in heart failure Symptoms Heart failure is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and/or... read more Symptoms .

  • Viral infections, and some hormonal disorders are common causes of dilated cardiomyopathy.

  • Shortness of breath and fatigue are often the first symptoms.

  • Electrocardiography, echocardiography, and magnetic resonance imaging are used to diagnose dilated cardiomyopathy.

  • Doctors try to treat the cause of this cardiomyopathy, usually by giving drugs.

The term cardiomyopathy is used only when a disorder directly affects the heart muscle. Other heart disorders, such as coronary artery disease and heart valve disorders, also can eventually cause the ventricles to enlarge and heart failure. However, doctors do not classify the heart muscle problems caused by those disorders as cardiomyopathies.

Dilated cardiomyopathy can develop at any age but is more common in adults younger than about 50 years of age. About 10% of people who develop dilated cardiomyopathy are older than 65. In the United States, the disorder occurs in about 3 times as many men as women and 3 times as many blacks as whites. About 5 to 8 of every 100,000 people develop dilated cardiomyopathy each year.

Causes of Dilated Cardiomyopathy

The most common causes of dilated cardiomyopathy are

  • Viral infections

  • Genetic disorders (genetic factors play a role in 20 to 35% of cases)

The virus or bacteria infects and weakens the heart muscle. As a result, the heart cannot pump as forcefully. The damaged heart muscle is replaced by fibrous (scar) tissue. The heart muscle then stretches resulting in enlargement of the heart chambers and reduced pumping ability. After that point, heart failure Heart Failure (HF) Heart failure is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and/or... read more Heart Failure (HF) develops.

Other causes of dilated cardiomyopathy include

Rare causes of dilated cardiomyopathy include pregnancy (peripartum cardiomyopathy Peripartum cardiomyopathy Most women who have heart disorders—including certain heart valve disorders (such as mitral valve prolapse) and some birth defects of the heart—can safely give birth to healthy children, without... read more ), iron overload Overview of Iron Overload Iron is essential for life, so the body usually tightly controls iron absorption from food and recycles the iron from red blood cells. People lose small amounts of iron every day, and even a... read more , and connective tissue disorders such as rheumatoid arthritis Rheumatoid Arthritis (RA) Rheumatoid arthritis is an inflammatory arthritis in which joints, usually including those of the hands and feet, are inflamed, resulting in swelling, pain, and often destruction of joints.... read more Rheumatoid Arthritis (RA) , systemic lupus erythematosus Systemic Lupus Erythematosus (SLE) Systemic lupus erythematosus is a chronic autoimmune inflammatory connective tissue disorder that can involve joints, kidneys, skin, mucous membranes, and blood vessel walls. Problems in the... read more Systemic Lupus Erythematosus (SLE) (lupus), and systemic sclerosis Systemic Sclerosis Systemic sclerosis is a rare, chronic autoimmune rheumatic disorder characterized by degenerative changes and scarring in the skin, joints, and internal organs and by blood vessel abnormalities... read more Systemic Sclerosis . Extreme stress can also sometimes cause a type of dilated cardiomyopathy called Takotsubo cardiomyopathy. Diseases such as sarcoidosis Sarcoidosis Sarcoidosis is a disease in which abnormal collections of inflammatory cells (granulomas) form in many organs of the body. Sarcoidosis usually develops in people aged 20 to 40, most often people... read more Sarcoidosis can also cause dilated cardiomyopathy.

When no specific cause can be identified, the disorder is called an idiopathic dilated cardiomyopathy.

Symptoms of Dilated Cardiomyopathy

Usually, the first symptoms of dilated cardiomyopathy are becoming short of breath during exertion and tiring easily. These symptoms result from a weakening of the heart’s pumping action, which is called heart failure Heart Failure (HF) Heart failure is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and/or... read more Heart Failure (HF) . Some people have chest pain.

When cardiomyopathy results from an infection, the first symptoms may be a sudden fever and flu-like symptoms.

Complications

Heart failure Heart Failure (HF) Heart failure is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and/or... read more Heart Failure (HF) can develop whatever the cause of dilated cardiomyopathy, if the heart damage is severe enough. With heart failure, the fluid is retained in the legs and abdomen (causing swelling), and the lungs fill with fluid (causing shortness of breath with physical activity and while lying flat). With severe heart failure, blood pressure can be low due to the weakness of the heart.

Heart valve problems Overview of Heart Valve Disorders Heart valves regulate the flow of blood through the heart's four chambers—two small, round upper chambers (atria) and two larger, cone-shaped lower chambers (ventricles). Each ventricle has... read more Overview of Heart Valve Disorders may develop. Because the heart is enlarged, the heart valves may be unable to close normally and often allow blood to leak back into the heart chamber rather than flowing into the next blood vessel or chamber (called regurgitation Overview of Heart Valve Disorders Heart valves regulate the flow of blood through the heart's four chambers—two small, round upper chambers (atria) and two larger, cone-shaped lower chambers (ventricles). Each ventricle has... read more Overview of Heart Valve Disorders ). The valves most often affected are the mitral valve, which is positioned between the left atrium (upper heart chamber) and the left ventricle (lower heart chamber), and the tricuspid valve, which is positioned between the right atrium and the right ventricle. Leakage causes heart murmurs, which doctors can hear with a stethoscope.

Abnormal heart rhythms Overview of Abnormal Heart Rhythms Abnormal heart rhythms (arrhythmias) are sequences of heartbeats that are irregular, too fast, too slow, or conducted via an abnormal electrical pathway through the heart. Heart disorders are... read more Overview of Abnormal Heart Rhythms (arrhythmias) can result from damage to and stretching of the heart muscle. Arrhythmias may cause sensation of irregular heartbeats (palpitations) or sudden death. The leakage of the valves and the abnormal heart rhythms may interfere further with the heart’s pumping action.

Blood clots may form on heart chamber walls because blood can pool in the enlarged heart, particularly when the ventricles are very dilated and poorly contracting. The clots can break into pieces (becoming emboli), travel from the heart to blood vessels elsewhere in the body, and block them, causing damage to the organ they supply. If the blood supply to the brain is blocked, a stroke Overview of Stroke A stroke occurs when an artery to the brain becomes blocked or ruptures, resulting in death of an area of brain tissue due to loss of its blood supply (cerebral infarction) and symptoms that... read more can result.

Diagnosis of Dilated Cardiomyopathy

  • Imaging tests such as echocardiography or magnetic resonance imaging (MRI) of the heart

  • Sometimes, a biopsy of the heart muscle

  • Sometimes, testing for the cause and/or complications

The diagnosis of dilated cardiomyopathy is based on the person's symptoms, the results of a physical examination, and additional tests. Doctors look for other causes of a dilated heart, such as a previous heart attack, chronic high blood pressure, or a damaged heart valve.

Blood tests for common viruses that can cause dilated cardiomyopathy are done when doctors suspect infection as a cause.

Electrocardiography (ECG) may detect abnormalities in the electrical activity of the heart. However, these abnormalities are usually not sufficient evidence for a diagnosis.

Because genetic disorders may cause dilated cardiomyopathy, family members may also be tested.

Imaging of the heart

Biopsy and cardiac catheterization

If the diagnosis remains in doubt, cardiac catheterization Cardiac catheterization Cardiac catheterization and coronary angiography are minimally invasive methods of studying the heart and the blood vessels that supply the heart (coronary arteries) without doing surgery. These... read more Cardiac catheterization , an invasive procedure in which a catheter is threaded from a blood vessel in the arm, neck, or leg into the heart, can provide additional information about the pumping ability of the heart. During cardiac catheterization, doctors can also obtain a biopsy (remove a tissue sample from inside the heart for examination under a microscope), measure pressures in the heart chambers and exclude coronary artery disease.

Prognosis of Dilated Cardiomyopathy

The prognosis of dilated cardiomyopathy varies considerably depending on many factors. In general, the prognosis worsens as the heart becomes more dilated and functions less well. Abnormal heart rhythms also indicate a worse prognosis. Overall, men survive only half as long as women, and blacks survive half as long as whites.

About 40 to 50% of deaths are sudden, probably resulting from an abnormal heart rhythm or an embolus that blocks blood flow in a critical area. Additional factors include the cause and severity of the cardiomyopathy, the person's age and ability to follow medical advice, access to specialized treatment, poor patient compliance with drugs, salt in the diet, and outpatient visits. However, in recent years overall prognosis has improved with current treatments, especially with the introduction of implantable cardioverter-defibrillators, cardiac resynchronization therapy, and other interventions.

Treatment of Dilated Cardiomyopathy

  • Drugs

  • Sometimes, device therapy with a defibrillator and/or pacemaker

If possible, doctors treat the disorder that is causing the dilated cardiomyopathy. For example, immunosuppressive drugs such as corticosteroids may be used to treat a connective tissue disorder that caused dilated cardiomyopathy.

General treatment measures include avoiding stress, limiting salt in the diet, and having periods of rest, which help reduce strain on the heart, particularly when the cardiomyopathy is acute or severe.

Drugs for dilated cardiomyopathy

Drugs used for heart failure Drug Treatment for Heart Failure Heart failure is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and/or... read more , such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, beta-blockers, neprilysin inhibitors, aldosterone antagonists (spironolactone or eplerenone), sodium glucose cotransporter 2 protein (SGLT) inhibitors, the combination of hydralazine and nitrates, and ivabradine, improve the heart’s pumping function, prolong life, and help to decrease persistent symptoms.

Diuretics (drugs that increase urination) are used to reduce excess fluid in the lungs and decrease symptoms of swelling due to fluid retention, but they do not prolong life.

Digoxin may help the heart's pumping and decrease the number of hospitalizations for heart failure, but it does not prolong life.

Antiarrhythmic drugs may be given to treat abnormal heart rhythms. Most of these drugs are initially prescribed in small doses. Doses are increased in small increments because if the dose is too large, an antiarrhythmic drug may worsen heart rhythm abnormalities or depress pumping function.

Drugs to prevent blood clots, such as warfarin or aspirin, may be used, particularly when ventricles are very dilated and contracting poorly.

Special precautions are needed when drugs are given to women with peripartum cardiomyopathy because some of the drugs usually used to treat cardiomyopathy may be absorbed into breast milk and harm the nursing infant.

Device therapy

Some people have an abnormality of the electrical conduction in the heart, which can be helped by an artificial pacemaker Artificial pacemakers Abnormal heart rhythms (arrhythmias) are sequences of heartbeats that are irregular, too fast, too slow, or conducted via an abnormal electrical pathway through the heart. Heart disorders are... read more Artificial pacemakers that stimulates first the atria and then both ventricles (cardiac resynchronization therapy). This type of pacemaker, when used in the right person, will help to return the contraction pattern of the heart toward normal and improve its function.

Heart transplantation

Heart failure in dilated cardiomyopathy can be progressive and ultimately fatal. Because of this poor prognosis, dilated cardiomyopathy is the most common reason for heart transplantation Heart Transplantation Heart transplantation is the removal of a healthy heart from a recently deceased person and then its transfer into the body of a person who has a severe heart disorder that can no longer be... read more or mechanical heart support with a left ventricular assist device. Successful heart transplantation cures the disorder, but it has its own complications and limitations.

More Information

The following is an English-language resource that may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

Drugs Mentioned In This Article

Generic Name Select Brand Names
ALDACTONE
No US brand name
INSPRA
Ivabradine
COUMADIN
LANOXIN
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