Dilated cardiomyopathy (DCM) decreases the heart's ability to pump blood because the heart's main pumping chamber, the left ventricle, is enlarged and weakened. When this condition progresses it leads to heart failure.
Heart failure means that the heart is facing trouble in keeping up with your body's demand for oxygen and blood (which is carried in the blood). Dr Hemant Pathare, Consultant cardiovascular Thoracic Surgeon at Jaslok Hospital and Research Centre highlights the symptoms, causes and treatment of dilated cardiomyopathy.
What Are the Symptoms of DCM?
Many people with DCM are asymptomatic or have minor symptoms, and live a relatively normal life. Symptoms will progress as the heart function worsens.
- Exertional breathlessness
- Breathlessness whilst lying down or asleep
- Swelling in the feet
- Fatigue (feeling overly tired).
- Unexplained weight gain
- Fainting or lightheadedness (due to irregular heart rhythms)
- Palpitations (Abnormal heart rhythms causing fluttering)
- Stroke or gangrene of leg or hand d/t breakage of Blood clots from the dilated left ventricle
- Chest pain or pressure
- Sudden death
Causes
DCM can be inherited, but it can also be caused by:
- Severe untreated coronary artery disease
- Chronic Alcoholism
- Thyroid disease
- Uncontrolled Diabetes
- Viral infections of the heart
- Structural Heart valve abnormalities
- Chemotherapy
How Is DCM Diagnosed?
Based on medical history, detailed physical exam, specialised blood tests, electrocardiogram, chest X-ray, 2 D echocardiogram, Cardiac PET, stress test and cardiac MRI.
Treatment
Medications:
Always the first line comprises of either /or Diuretics, Heart rate control drugs, ARNIs, Blood thinners and IV Inotropes.
Lifestyle changes:
Salt restriction and fluid restriction are the cornerstones of management.
Advanced DCM may need pacemakers, CRT (Cardiac resynchronisation by the biventricular pacemaker). Implantable cardioverter defibrillators (ICD) are usually suggested for people at risk for life-threatening arrhythmias or sudden cardiac death. When an ICD recognises a very fast, abnormal rhythm, it ''shocks'' the heart muscle back into a regular rhythm.
Surgery:
Your doctor may recommend surgery for coronary artery disease (CABG) or valve disease. (Repair or replacement). For end-stage heart failure there are 2 options:
Left Ventricular and BiVentricularAssist Devices:
These are artificial titanium pumps which are placed within the heart and they pump up to 10 litres of blood into the circulation per minute. They are powered by an electromagnetic motor attached by an external driveline to a wearable battery weighing 500gms. They do not require immune-suppression. They are offered as Destination therapy or as a bridge transplant.
Orthotopic Heart transplant:
If your candidacy is confirmed after going through a series of specialised tests then your diseased failing heart will be replaced by a healthy donor heart thus giving you a new lease of life.
