Dilated Cardiomyopathy Oakville
Dilated Cardiomyopathy
What is Dilated Cardiomyopathy?
Dilated Cardiomyopathy is the most common type of cardiomyopathy, and occurs when the heart chambers enlarge. The disease process begins in the left ventricle, which is normally responsible for pumping blood out of the heart to the rest of the body. As the left ventricle dilates, the muscular wall of the heart thins and stretches; weakening the ability of the heart to pump blood out of the heart. Over time, dilated cardiomyopathy will involve the right ventricle and the two upper cardiac chambers (right and left atrium), and will lead to symptoms of heart failure.
What are the Symptoms of Dilated Cardiomyopathy?
In the early stages, there may be no symptoms. Once heart failure develops however, symptoms include:
- Shortness of breath and feeling congested
- Exercise intolerance – an inability to carry out daily activities due to fatigue or exhaustion
- Swelling in the legs, ankles and/or feet (edema)
- Cough - especially at night or when lying down
- Abdominal bloating
- Weight gain
- Angina – chest pressure, pain or discomfort
- Palpitations – fluttering sensation in the chest due to an arrhythmia
- Dizziness, lightheadedness, or fainting
What are the complications of Dilated Cardiomyopathy?
- Heart Failure
- Kidney Failure
- Heart Valve Disease – especially mitral regurgitation and tricuspid regurgitation
- Blood clots – usually within the left ventricle
- Stroke – blood clots within the left ventricle that travel to the brain
- Arrhythmias (abnormal heart rhythms)
- Cardiogenic Shock
- Cardiac Arrest / Sudden Death
How is symptomatic Dilated Cardiomyopathy treated?
Dilated cardiomyopathy is a type of non-ischemic cardiomyopathy, and thus management is very similar. As with nonischemic cardiomyopathy, the management of dilated cardiomyopathy is a multi-pronged approach. Determining the etiology is important, as it has implications on the overall prognosis. If possible, mitigating exposure to the offending agent is of critical importance. Secondly, management by an Advanced Heart Failure Cardiologist is important, as these conditions typically require leadership and a coordinated oversight of medical, device and surgical therapeutic options.
Medications
Medications have 2 Goals:
- Manage symptoms of heart failure
- Improve long term survival and pump function
Your Advanced Heart Failure Specialist may prescribe four medications that improve heart function, referred to as “Quadruple Therapy”.
These include:
- B-blocker – such as carvedilol
- An ACE-inhibitor/ARB/ARNI – such as Entresto®
- A Mineralocorticoid Inhibitor – such as spironolactone
- An SGLT2 inhibitor – such as dapagliflozin
You may also receive medications designed to make you feel better. These include diuretics, such as Furosemide.
Implantable Cardioverter-Defibrillator (ICD)
An Implantable Cardioverter-Defibrillator (ICD) monitors your heart rhythm for any dangerous rhythms originating in the lower chambers (ventricles) of the heart. These rhythms can lead to sudden death. An ICD detects these rhythms within seconds and delivers a shock (defibrillation) to restore the heart rhythm to normal (sinus rhythm).
Cardiac Resynchronization Therapy (CRT)
A Cardiac Resynchronization Therapy (CRT) device senses and produces heartbeats in both the right and left sides of the lower chambers of the heart (ventricles), which allows the heart to pump in a more synchronized fashion. This reduces heart failure symptoms and increases the hearts pump function, over time.
The CRT device can be combined with an ICD, and this is called a CRT-D device. Your Advanced Heart Failure Cardiologist and Electrophysiologist will collaborate on the best device for you, and the optimal timing for implantation.
Mitraclip® / Triclip®
As the heart enlarges, certain valves may not close properly. This is commonly seen with the mitral valve and tricuspid valves. Your Advanced HF Cardiologist will determine if/when referral for surgical valve repair/replacement are necessary or if percutaneous options such as the Mitraclip® or Triclip® are viable considerations.
Left Ventricular Assist Device (LVAD)
A left ventricular assist device (LVAD) is for patients with end-stage heart failure, as either a means to bridge the delay while awaiting transplantation, or as a final (destination) therapy for those who are ineligible for cardiac transplantation.
A LVAD is a surgically implanted device that assists the lower chamber of the heart (left ventricle) in pumping blood to the rest of the body. By providing oxygen-rich blood to the vital organs, this will improve the function of the kidneys, liver, brain, and many other organs. They also improve quality of life, as they will improve symptoms of heart failure, which includes exercise intolerance, and symptoms of fatigue, shortness of breath, and leg swelling.
Cardiac Transplantation
Cardiac Transplantation is a limited resource, and may be offered to those with end stage heart failure, whereby the failing heart is replaced with a healthier donor heart. It is a valuable resource that can add to your quality of life and longevity. However, it is not a cure for heart failure, and replaces one set of issues for another set. Candidacy for cardiac transplantation must first be assessed by a panel of advanced heart failure cardiologists and surgeons, to deem eligibility.
Frequently Asked Questions
Yes, moderate intensity aerobic-type exercise is safe, and improves cardiovascular fitness. This has been studied in trials specifically evaluating heart failure patients, and has demonstrated improved quality of life, functional abilities, and an improvement in the contractility of the heart over time. As with any exercise program, you may wish to speak to your cardiologist prior to starting a new program. Referral to a local Cardiac Rehabilitation program is also an excellent resource as well.
The prognosis of dilated cardiomyopathy is dependent upon the cause of the cardiomyopathy itself. Some have a very good prognosis, with the removal of the offending agent and medical optimization of heart failure. Others, have a less than optimal natural progression without prompt medical attention. Fortunately, in this modern era, there are many new medications and device therapies that can manage heart failure, and improve upon the hearts ability to pump. This translates into improved survival and quality of life.
Still have a question about dilated cardiomyopathy? Speak to your doctor about a referral to the Chahal Cardiovascular Centre for an Advanced Heart Failure consultation.
