What is dilated cardiomyopathy?
Dilated cardiomyopathy (DCM) is a condition in which the left ventricle, the heart’s main pumping chamber, is enlarged (dilated). As the chamber gets bigger, its thick muscular wall stretches, becoming thinner and weaker. This affects the heart’s ability to pump enough oxygen-rich blood to the rest of the body.
The problem can then spread to the other chambers of the heart. Dilated cardiomyopathy can lead to heart valve problems, arrhythmia, blood clots in the heart, heart failure, and even sudden cardiac death.
About a third of the people with dilated cardiomyopathy inherit it from their parents. Other causes of DCM include:
- Autoimmune disease
- Complications during or after pregnancy
- Coronary heart disease
- Diabetes
- Exposure to toxins, including alcohol, illegal drugs, and certain cancer treatments
- Heart attack
- High blood pressure
- Thyroid disease
- Viral infections, such as hepatitis and HIV
Dilated cardiomyopathy symptoms
The symptoms of dilated cardiomyopathy vary, tend to get worse over time, and include:
- Chest pain
- Fatigue
- The feeling of fluttering or palpitations in the chest
- Heart murmur
- Trouble breathing because of fluid in the lungs
- Swollen legs, ankles and belly
Diagnosis of dilated cardiomyopathy
Finding the underlying cause of DCM is important to determining the right treatment. At Penn Medicine our team conducts a comprehensive diagnosis that may include:
- Physical exam and medical history: We ask you detailed questions about your medical history and family medical history. Then we do a thorough exam to look for features of dilated cardiomyopathy.
- Blood tests: Lab tests can measure iron in the blood or find markers of autoimmune disease, thyroid disease, infection and other conditions.
- Cardiac catheterization: This test can measure pressure in and around your heart.
- Coronary angiography: This test takes images of the coronary arteries (blood vessels) to look for disease.
- Echocardiogram (echo): This test uses ultrasound waves to take pictures of the heart’s structure.
- Electrocardiogram (ECG): This test records the electrical impulses in the heart to detect any abnormal patterns in rate or rhythm.
- Electrophysiology study: An electrophysiologist inserts a thin tube through a blood vessel and into the heart to measure electrical activity. This test can help assess the risk of sudden death.
- Genetic testing and counseling: A genetic specialist can help you determine whether you or your family members should have genetic testing to look for variants (genetic changes) that cause DCM. Anyone having genetic testing should also have genetic counseling to understand the process and what it might mean for you and your family.
- Holter monitor: This is a wearable device that monitors the heart’s electrical activity as you go about your daily activities.
- Other imaging tests: We have many options to take pictures inside your heart, including CT, MRI, nuclear heart scan and MUGA scan.
- Stress test: Also called an exercise test, this measures heart function while you walk or run on a treadmill.
Dilated Cardiomyopathy Treatment at Penn Medicine
There is no cure for DCM, but consistent monitoring can help identify problems before they interfere with your health. Treatment for dilated cardiomyopathy varies, depending on each individual’s condition and symptoms.
Medications used for treatment of DCM include:
- Aldosterone antagonists, which block an artery-tightening hormone called aldosterone
- Angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), which reduce the heart’s workload
- Anti-arrhythmia medications to control the rate and rhythm of the heartbeat
- Beta blockers, which lessen the rate and force of the heart’s contractions
- Blood thinners to prevent clots and stroke
- Diuretics (water pills) to reduce fluid build-up
- Neprilysin inhibitors, which have similar effects as ACE inhibitors and ARBs and also help the body eliminate salt to reduce certain symptoms
- SLGT2 inhibitors, which reduce the risk of cardiovascular death in patients with heart disease and diabetes
Some people with DCM need surgery to correct underlying conditions, such as:
- Coronary artery bypass grafting (CABG) surgery or angioplasty to open blockages and improve blood flow
- Surgery to repair or replace faulty heart valves
- Implantable devices to regulate the heart rate and rhythm, such as a pacemaker or implantable cardioverter defibrillator (ICD)
- Ventricular assist devices that help pump blood out of the left ventricle
- Heart transplantation with a deceased donor’s heart for advanced cases
The Penn Medicine network has specialists with extensive training and experience in cardiomyopathy and all its possible treatments. They work together to create a comprehensive treatment plan for dilated cardiomyopathy. Your team may include experts in: