Dilated Cardiomyopathy (DCM)

Dilated cardiomyopathy (DCM) is the most common type of the disease.

It mostly occurs in adults 20 to 60. Men are more likely than women to
have this type of cardiomyopathy.
This condition may be defined as an ejection fraction of less than 40% in
the presence of increased left ventricular dimension (left ventricular enddiastolic size more than 115% of that calculated for age and body
surface area). Increased left ventricular dimensions in the presence of
preserved systolic function may be a precursor to the development of
systolic dysfunction in certain individuals. Pharmacologic intervention
with angiotensin-converting enzyme inhibitors and beta blockers may
prevent this progression to heart failure in some of these individuals.
Dilated cardiomyopathy affects the heart's ventricles and atria. These are
the lower and upper chambers of the heart, respectively.
The disease often starts in the left ventricle, the heart's main pumping
chamber. The heart muscle begins to dilate (stretch and become
thinner). This causes the inside of the chamber to enlarge. The problem
often spreads to the right ventricle and then to the atria as the disease
gets worse.
When the heart chambers dilate, the heart muscle doesn't contract
normally. Also, the heart can't pump blood very well. Over time, the heart
becomes weaker and heart failure can occur. Common symptoms of
heart failure include shortness of breath, fatigue (tiredness), and swelling
of the ankles, feet, legs, abdomen and veins in the neck.
Dilated cardiomyopathy also can lead to heart valve
problems, arrhythmias (irregular heartbeats) and blood clots in the heart.
Other Names for Dilated Cardiomyopathy
Alcoholic cardiomyopathy. This term is used when overuse
of alcohol causes the disease.
Congestive cardiomyopathy
Diabetic cardiomyopathy
Familial dilated cardiomyopathy
Idiopathic cardiomyopathy

 Ischemic cardiomyopathy. This term is used when coronary heart

disease (also called coronary artery disease) or heart attack cause
the disease. Not all forms of DCM are ischemic in origin.
Peripartum cardiomyopathy. This term is used when the disease
develops in a woman shortly before or after she gives birth.
Primary cardiomyopathy
What Causes Dilated Cardiomyopathy
The cause of dilated cardiomyopathy often isn't known. As many as onethird of the people who have dilated cardiomyopathy inherit it from their
parents.
Certain diseases, conditions and substances also can cause the disease,
such as:
Coronary heart disease, heart attack, high blood pressure, diabetes,
thyroid disease, viral hepatitis and HIV
Alcohol, especially if you also have a poor diet
Infections, especially viral infections that inflame the heart muscle
Complications during the last month of pregnancy or within 5
months of birth
Certain toxins such as cobalt
Certain drugs (such as cocaine and amphetamines) and two
medicines used to treat cancer (doxorubicin and daunorubicin)
What Are the Symptoms of DCM?
Many people with dilated cardiomyopathy have no symptoms or only
minor symptoms, and live a normal life. Other people develop symptoms,
which may progress and worsen as heart function worsens.
Symptoms of DCM can occur at any age and may include:

Heart failure symptoms (shortness of breath and fatigue).

Swelling of the lower extremities.
Fatigue (feeling overly tired).
Weight gain.
Fainting (caused by conditions such as irregular heart rhythms,
abnormal responses of the blood vessels during exercise, or no
cause may be found).

 Palpitations (fluttering in the chest due to abnormal heart rhythms).

Dizziness or lightheadedness.
Blood clots can form in the dilated left ventricle as a result of
pooling of the blood. If a blood clot breaks off, it can lodge in
an artery and disrupt blood flow to the brain, causing stroke. A clot
can also block blood flow to the organs in the abdomen or legs.
Chest pain or pressure.
Sudden death.

How Is DCM Diagnosed?

DCM is diagnosed based on medical history (your symptoms and family history), physical
exam, blood tests, electrocardiogram (ECG or EKG), chest Xray, echocardiogram, exercise stress test, cardiac catheterization, CT scan, and MRI.
Another test rarely done to determine the cause of a cardiomyopathy is a myocardial
biopsy, or heart biopsy, where a tissue sample is taken from the heart and examined
under a microsope to determine the cause of the symptoms.
If you have a relative with dilated cardiomyopathy, ask your doctor if you should be
screened for the condition. Genetic testing may also be available to identify abnormal
genes.

What Is the Treatment for DCM?

Treatment of dilated cardiomyopathy is aimed at decreasing the heart size and the
substances in the bloodstream that enlarge the heart and ultimately lead to worsened
symptoms:
Medications: To manage heart failure, most people improve by taking drugs, such as
a beta-blocker,ACE inhibitoror an ARB, and/or diuretics. If you have
anarrhythmia (irregular heart beat), your doctor may give you a medication to control
your heart rate or lessen the occurrence of arrhythmias. Blood thinners may be used to
prevent blood clots from occurring.
Lifestyle changes: If you have heart failure, you should reduce sodium in your diet based
on your doctor's recommendations. Your doctor may recommend aerobic exercise, but
don't do heavy weight lifting.

What Surgeries Are Used to Treat DCM?

People with severe DCM may need one of the following surgeries:

Cardiac resynchronization by biventricular pacemaker. For some people with

DCM, stimulating both the right and left ventricles with this pacemaker improves the
heart's ability to contract with more force, thereby improving symptoms and increasing the
length of time you can exercise. This pacemaker also will help people with heart block or
some bradycardias (slow heart rates).
Implantable cardioverter defibrillators (ICD). ICDs are suggested for people at

risk for life-threatening arrhythmias or sudden cardiac death. The ICD constantly monitors
the heart rhythm. When it detects a very fast, abnormal heart rhythm, it ''shocks'' the heart
muscle into returning to a normal rhythm.
Surgery. Conventional surgeries for coronary artery disease or valvular disease

may be recommended. Some people may be eligible for surgical repair of the left ventricle
or placement of a cardiac assist device.
Heart transplant

Ejection fraction
What is ejection fraction?
Ejection fraction is a test that determines how well your heart pumps
with each beat.
Left ventricular ejection fraction (LVEF) is the measurement of how
much blood is being pumped out of the left ventricle of the heart (the
main pumping chamber) with each contraction.
Right ventricular ejection fraction (RVEF) is the measurement of
how much blood is being pumped out of the right side of the heart to the
lungs for oxygen.
In most cases, the term ejection fraction refers to left ventricular
ejection fraction.
How the Heart Works
A healthy heart beats about 60 to 80 times per minute to pump blood
throughout the body. The right and left sides of the heart work together.
Blood that is low in oxygen first enters the right upper chamber (right
atrium) of the heart. The blood flows from the right atrium to the lower
chamber (right ventricle) through the open tricuspid valve. Blood passes
through a valve before leaving each chamber of the heart. There are four
valves in your heart; valves make sure blood flows in only one direction
through your heart. The blood then travels through the pulmonary artery
to the lungs where oxygen is added.
Oxygen-rich blood then returns to the left side of the heart. The blood
flows from the left upper chamber (left atrium) to the lower chamber (left
ventricle) through the open mitral valve. From the left ventricle, the

blood is pumped into a network of arteries (blood vessels) that carry the
blood throughout the body.
What do the numbers mean?
Ejection fraction is usually expressed as a percentage. A normal heart
pumps a little more than half the hearts blood volume with each beat.
(1)
A normal LVEF ranges from 55-70%. A LVEF of 65, for example, means
that 65% of the total amount of blood in the left ventricle is pumped out
with each heartbeat.
The LVEF may be lower when the heart muscle has become damaged
due to a heart attack, heart muscle disease (cardiomyopathy), or other
causes.
An EF of less than 40% may confirm a diagnosis of heart failure.
Someone with diastolic failure can have a normal EF.
An EF of less than 35% increases the risk of life- threatening irregular
heartbeats that can cause sudden cardiac arrest (loss of heart function)
and sudden cardiac death. An implantable cardioverter defibrillator (ICD)
may be recommended for these patients.
Your EF can go up and down, based on your heart condition and the
therapies that have been prescribed.

EjectionFraction
Measurement

What it Means

55-70%

Normal

40-55%

Below Normal

Less than 40%

May confirm diagnosis of heart failure

<35%

Patient may be at
irregular heartbeats

risk

of

life-threatening

How is EF measured?
EF can be measured in your doctors office during tests such as:

Ultrasound of the heart (echocardiography) used most often

Cardiac catheterization
Magnetic resonance imaging (MRI) scan of the heart
Nuclear medicine scan (multiple gated acquisition or MUGA) of the
heart; also called a nuclear stress test

Computerized tomography (CT) scan of the heart

Why Its Important to Know Your EF

If you have a heart condition, it is important for you and your doctor to
know your EF.
Your EF can help your doctor determine the best course of treatment for
you and the effectiveness of the therapies that have been prescribed.
You should have your EF measured initially when you are first diagnosed
with a heart condition, and again as needed, based on changes in your
condition. Ask your doctor how often you should have your EF checked.
What is heart failure?
Heart failure means:

The muscles of the heart are weaker than normal or the lower
chambers of the
heart are not able to relax and fill with blood as they normally do

Less blood is pumped out of the heart to organs and tissues in the
body

Pressure in the heart increases

Heart failure does not mean that your heart has stopped working.
When the heart cannot pump enough oxygen and nutrients to meet the
bodys needs, it tries to adapt. The chambers of the heart stretch to hold
more blood to pump through the body with each heartbeat. Hormones are
released into the bloodstream to increase the hearts pumping power and
increase blood flow into the heart chambers. These changes provide
temporary relief, but over time, the heart muscle walls continue to weaken
and/or stiffen.
There are two types of heart failure:

Systolic left ventricular dysfunction (or systolic heart failure) occurs when the
left ventricle heart muscle doesn't contract with enough force, so less oxygen-rich
blood is pumped throughout the body.
Heart failure with preserved left ventricular function (diastolic heart failure)
occurs when the heart contracts normally, but the ventricles do not relax properly or
are stiff and less blood enters the heart during normal filling. In this case, the ejection
fraction may be normal.