What is Dilated Cardiomyopathy?
The American Heart Association estimates that 4.9 million people in the Unites States have heart failure (www.americanheart.org). Dilated cardiomyopathy, a progressive disease of heart muscle, is the third most common cause of heart failure (www.americanheart.org) and the most frequent cause of heart transplantation. The word dilated refers to the enlarged state of the heart in DCM, and the word cardiomyopathy means disease of the heart muscle.
Dilated cardiomyopathies are associated with both systolic abnormalities (difficulty of the left ventricle to empty or eject blood from its chamber) and diastolic abnormalities (increased resistance to filling of one or both ventricles). Heart enlargement and poor function generally lead to progressive heart failure with further decline in the ability of the heart to contract and pump blood around the body efficiently.
Since DCM us one cause of heart failure, symptoms of DCM are the same as those of heart failure and may include:
- Breathlessness (shortness of breath). In mild cases, shortness of breath occurs during exertion (e.g., walking up a hill). With more severe heart failure shortness of breath may occur while resting or lying flat.
- Fluid retention in the legs. Fluid retention in the body mainly affects the legs due to the effect of gravity. At first, some swelling may occur in the feet at the end of the day. In time, the swelling may gradually affect the lower parts of the legs, or higher if it is not treated. For many people there is a gradual buildup of fluid.
- Tiredness. This can range from mild to severe tiredness.
DCM Diagnosis and Treatment
Dilated cardiomyopathy is diagnosed by a physical examination, an EKG (to evaluate heart response), an echocardiogram (looks at the structure of the heart), and exercise testing (to evaluate changes in electrical patterns before and after exercise). These tests are all noninvasive tests. Invasive tests that may be used to evaluate DCM include coronary angiogram (uses a dye to reveal narrowing in the coronary arteries), transesophageal echocardiogram (provides detailed pictures of the heart taken from the esophagus) and MRI (scan that uses a magnetic field to create images of the heart).
There is no cure for DCM; however, medicines including ACE inhibitors, beta blockers, anticoagulants and diuretics help to control symptoms of heart failure. Other treatments for patients with more advanced disease may include an implantable cardioverter defibrillator (ICD).
Patients with End-Stage Heart Failure Due to DCM
When medication therapy and an ICD are no longer effective, device-based management may be initiated such as left ventricular assist devices, or a total artificial heart. Finally, cardiac transplantation may be performed using a heart from a donor.
Clinical trials exploring stem cell therapy for DCM
Experimental treatments for end-stage heart failure include the use of growth factors, protein therapies, and cell-based therapies. New or ongoing clinical trials for these experimental therapies can be found on Clinicaltrials.gov, a registry of federally and privately supported clinical trials conducted in the United States and around the world. Or, visit our DCM Clinical Trials page to learn more about Aastrom’s trials for dilated cardiomyopathy.