What is dilated cardiomyopathy?

Dilated cardiomyopathy refers to a condition that involves an enlargement, or dilation, of all 4 chambers of the heart, although initially, mainly the left ventricle is affected. The structure of the heart change as a result of an infiltration of the heart muscle with scar tissue. This leads to the chambers of the heart dilating, resulting in an enlarged heart. Usually, there is only moderate thickening of the heart muscle (myocardium).

Dilated cardiomyopathy leads to a reduction in the heart's ability to pump blood efficiently, thus reducing the amount of blood pumped out of the ventricle (ejection fraction). With the heart losing some of its natural elasticity, the ability of the chambers of the heart to fill with a sufficient amount of blood is restricted, resulting in heart failure. The severity of heart failure symptoms can be expressed using the NYHA system of classification. Using classes I-IV, this system describes symptoms in terms of the degree to which the patient's respiratory function is limited. Possible causes of dilated cardiomyopathy are manifold, and n many cases, several members of the same family are affected.

The main symptoms of heart failure

• Reduced exercise capacity
• Shortness of breath (dyspnea) when exercising or at rest
• Edema, for instance affecting the legs and lungs

What are possible causes?

Dilated cardiomyopathy can develop as a result of myocarditis, i.e. an inflammation of the heart muscle. Excessive consumption of alcohol can also be a causative factor. There are a whole range of other causative factors, but these tend to occur only rarely. In many cases, it is impossible to identify the exact cause of the disease.

Diagnosis

Echocardiography is the primary diagnostic method used, as it allows visualization of the enlarged chambers of the heart, reduced wall thickness and left ventricular ejection fraction (how well the left ventricle is working). In some cases, magnetic resonance imaging (MRI) and an endomyocardial biopsy may also be used as diagnostic tools.

Treatment

Medicines used to treat heart failure include beta blockers, ACE inhibitors (angiotensin II receptor blockers, ARBs) and diuretics. Patients who develop atrial fibrillation are treated with anticoagulants.

If drug treatment is not effective on its own, electrophysiology procedures. may be used. Cardiac resynchronization therapy, or CRT, is the method of choice for patients with both low ejection fraction (the amount of blood pumped out of the heart with each contraction, compared to the volume of blood inside the ventricle prior to contraction) and left bundle branch block (a disruption in the normal flow of electrical pulses that drive the heart). Most of the CRT devices used therefore also contain a defibrillator, which protects the patient against life-threatening arrhythmias and sudden cardiac death

In some particularly severe cases, it may be necessary to consider surgery to implant an artificial device to support the heart (ventricular assist device). This type of surgery is also performed at Brandenburg Heart Center. Alternatively, the patient may be placed on a waiting list for a heart transplant.

Where can I find out more?

General information
Deutsche Herzstiftung e.V. (German Heart Foundation)
www.herzstiftung.de