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Dilated Cardiomyopathy (DCM): Causes, Symptoms, Diagnosis, And Treatment

by — Last updated: 2019-12-29 in Cardiovascular Disorders and Diseases

Of all the forms of cardiomyopathy, dilated cardiomyopathy is the most common. Diagnosing DCM, however, is not as easy as one may think and there may already be significant damage before doctors identify the condition.

Of all the forms of cardiomyopathy, dilated cardiomyopathy is the most common. Five to eight in every 100,000 people in the US suffer from dilated cardiomyopathy, while the condition is responsible for an estimated 46,000 hospitalizations and 10,000 deaths on a yearly basis. Most heart transplants are related to dilated cardiomyopathy. Adults between the ages of 20 and 60 have the highest risk of developing the condition.

Dilated cardiomyopathy affects the atria and ventricles of the heart as well as the upper and lower chambers. DCM usually begins in the principal pumping chamber of the heart – the left ventricle. It causes heart muscle dilation, a situation in which the muscles begin to thin out. As a result, the interior heart chamber becomes enlarged and the disease attacks the right ventricle before moving on to the atria. Heart chamber dilation prevents the heart muscles from contracting properly, limiting their ability to pump blood effectively. Over time, the heart grows weaker and patients are at risk of heart failure.

What causes dilated cardiomyopathy?

Not everyone with dilated cardiomyopathy will know why they developed it, but many cases are linked to genetics and run in families. All it needs is a trigger like pregnancy or viral infections. 

Should dilated cardiomyopathy be linked to genetics, their first-degree relatives — such as parents, children, and siblings — have to undergo screening for the disease as well. In this case, an electrocardiogram and echocardiogram will be conducted. A cardiologist will oversee the procedure. It may also be a good idea to test the relatives by checking their genes to see if they have a similar DCM-causing mutation. 

In most people with dilated cardiomyopathy, genetic testing will not affect their condition or its management in any way. However, this is not always the case, especially when gene mutation occurs in the lamin A/C gene. Identifying people who have such mutation is of paramount importance, because they have a higher tendency to experience sudden cardiac death. The procedure to avoid sudden cardiac death is to fit these patients with defibrillator implants. 

Apart from genetics, other possible causes of dilated cardiomyopathy include:

  • Heart-related viral infections like viral myocarditis.
  • Autoimmune diseases.
  • Toxins like alcohol and certain drugs.
  • Pregnancy. When DCM strikes during this time, or shortly after delivery, it is also known as peripartum cardiomyopathy.

How to recognize DCM: The symptoms

The task of recognizing DCM is not a walk in the park. Common symptoms, like trouble breathing, do not appear right away and may even be a symptom of a different condition altogether. A respiratory condition like asthma can lead to breathlessness, as well. Diagnosing DCM, therefore, becomes hard and there may already be significant damage done before doctors identify the condition.

The symptoms associated with DCM include:

  • Swelling in the ankles, belly, and legs due to fluid buildup in tissues. This results from the heart’s inability to pump properly.
  • Chest pain resulting from insufficient oxygen supply to the heart.
  • Tiredness due to a reduction in energy supply to tissues.
  • Breathlessness resulting from the accumulation of fluids inside the lungs.
  • Palpitations.
  • Mitral regurgitation, which is a leakage that results from the inability of the mitral valve to close tightly during ventricle contraction.

Diagnosis of dilated cardiomyopathy

To confirm whether or not a patient has DCM, doctors will use a range of tools:

  • A chest X-ray
  • A physical examination
  • A look at the symptoms that the patient experiences
  • The family history of the patient
  • An echocardiogram and electrocardiogram
  • An MRI
  • CT scans
  • Results from exercise stress tests
  • Blood tests
  • Cardiac catheterization
  • Myocardial biopsy – although this test is rarely conducted when looking to diagnose DCM, it is a heart biopsy where heart tissue samples are obtained and examined.

Treatment – does DCM have a cure?

If your doctor confirms that you have dilated cardiomyopathy, treatment will focus on protecting your heart from more damage and enhance your blood flow. 

DCM is often managed with the help of a combination of different medications. This depends on the symptoms that you experience. Some drugs that help to treat heart failure, as well as dilated cardiomyopathy, are beta blockers, angiotensin-converting enzyme (ACE) inhibitors, digoxin, diuretics, and blood-thinning medications.

Some implantable devices can help treat DCM as well. They include:

  • Implantable cardioverter-defibrillators that keep your heart rhythm in check, supplying electric shocks at certain times to control the heartbeat and keep it going.
  • Biventricular pacemakers that coordinate ventricular action through electrical impulses.
  • Left ventricular assist devices (LVADs) that are attached to and assist a weak heart in pumping blood. These implants go into the chest or abdomen. 

Another option to treat dilated cardiomyopathy is a heart transplant, where other forms of treatment like medications and implants no longer work.

Lifestyle changes play another important role in managing dilated cardiomyopathy, and patients can expect their doctors to encourage them to stick to heart-healthy low-salt diets and to participate in regular exercise. 

  • Photo courtesy of SteadyHealth

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