DCM - Dilated Cardiomyopathy

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-11-27 18:19

Dilated cardiomyopathy

Dilated cardiomyopathy (DCM) is the expansion (dilation) of one or both heart chambers. It is the most common type of heart muscle disease. Every year, there are around two to three new cases per 100,000 inhabitants. Men are affected more frequently than women. The mean age at diagnosis is around 40 years. The disease cannot be cured. However, thanks to modern heart failure therapy, the prognosis is improving noticeably.

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• What are the causes of dilated cardiomyopathy?
• What are the symptoms?
• How is the diagnosis made?
• How is dilated cardiomyopathy treated?

What are the causes of dilated cardiomyopathy?

A DCM can be of unknown origin (idiopathic) or caused by a variety of triggers, e.g.

• familial-genetic predisposition (in about 20 percent of DCM cases),
• Infections, especially with viruses (around 60 percent),
• Immune system disorders,
• toxic: especially in the case of chronic alcohol abuse,
• other heart diseases such as valve defects or CAD.

The cardiac muscles are damaged by the damaging influences and are interspersed with scar tissue. As a result, the heart cavities expand and the heart becomes enlarged. The heart muscle (myocardium) itself is usually only moderately thickened. The efficiency of the heart decreases and less blood can be pumped into the circulation. In addition, the heart loses its elasticity, which in turn leads to a reduced filling of the heart chambers. This leads to increasing damage to the heart.

What are the symptoms?

Many symptoms of dilated cardiomyopathy correspond to symptoms of heart failure. These include:

• Reduction in performance,
• progressive shortness of breath,
• Edema (including on the legs and in the lungs).

In the course of the disease, the heart failure can worsen and angina pectoris occur. Severe cardiac arrhythmias can lead to sudden cardiac death. Blood clots can form in the heart cavities, causing strokes and pulmonary embolisms.

How is the diagnosis made?

First of all, in a doctor-patient conversation, the complaints (e.g. decreasing resilience, shortness of breath, heart palpitations) are recorded. This is followed by a physical examination, cardiac ultrasound (echocardiography), EKG and a chest x-ray. In some cases, a cardiac catheterization and the removal of tissue samples from the heart muscle are required. To do this, a catheter is inserted through a large vein (e.g. in the groin) and advanced through the venous system into the heart. Here a small amount of tissue is removed with small forceps. Local anesthesia at the entry point of the catheter is usually sufficient.

How is dilated cardiomyopathy treated?

The primary goals are the treatment of any underlying diseases as well as the therapy of heart failure and cardiac arrhythmias. Drug inhibition of blood coagulation is often necessary in order to prevent the formation of blood clots and thus the risk of strokes and pulmonary embolisms.

If drug treatment is inadequate, a heart transplant may be considered. Mechanical pump systems are increasingly being used to bridge the gap until a transplant. This mechanical relief can lead to a certain recovery of the heart, so that a transplant is no longer necessary even after the pump system has been removed. The implantation of an artificial heart is also possible in exceptional cases.

The disease cannot be cured. Depending on the severity of the heart failure, around ten to 20 percent of those affected die within a year of being diagnosed as a result of the disease. Thanks to modern heart failure therapy, however, the prognosis is noticeably improving.