Do you sometimes feel unusually tired for no reason? Do you feel short of breath even when climbing a small flight of stairs? Most of the time, we don't think of these as normal things. However, sometimes there may be a problem with our heart that we don't know about. Today we are talking about a condition that gradually weakens the heart, but many people don't know about it. That is Dilated Cardiomyopathy.
What exactly is Dilated Cardiomyopathy?
Simply put, this is when your heart muscle stretches and becomes larger than normal. Just as a rubber band loses its elasticity when stretched, our heart muscle stretches, thins, and weakens.
This condition mainly starts in the left ventricle, the main pumping chamber of the heart. This chamber is the main part that pumps blood to the entire body. So when this muscle weakens, the heart cannot pump blood properly. Every time the heart beats, some of the amount of blood that needs to be pumped is left inside the heart. Over time, this becomes a big burden on the heart. It also reduces the amount of blood that the rest of the body needs to receive oxygen and nutrients.
Although there is no specific data on this in Sri Lanka, research has found that about 36 out of 100,000 people worldwide have this condition. But the good news is that there are now very effective treatments for this. And there are many things you can do to help manage this condition.
What are the symptoms of this condition?
Many people, especially in the early stages of the disease, do not experience any symptoms. However, as heart function gradually worsens, you may begin to experience symptoms. These symptoms usually do not come on suddenly but gradually increase.
| Symptom | A simple explanation |
|---|---|
| Difficulty breathing (Dyspnea) | Feeling short of breath while doing small tasks, walking, or even just standing. |
| Fatigue | Unusual, unbearable fatigue that you feel throughout the day, even after sleeping well. |
| Swelling of the legs, ankles, and abdomen (Edema) | Swelling of the legs, feet, and abdomen due to fluid accumulation in the body due to weak pumping action of the heart. |
| Palpitations | Feeling like your heart rate is suddenly increasing and your chest is pounding. |
| Dizziness and fainting | Dizziness, blue eyes, or fainting caused by insufficient blood flow to the brain. |
| Chest pain or discomfort | A pain that feels like a pressure on the chest, like there is a weight on it. |
| Cough and chest tightness | Persistent cough caused by fluid accumulation in the lungs. |
| Weight gain | Unexpected weight gain within a few days due to fluid retention in the body. |
What are the causes of Dilated Cardiomyopathy?
It is often difficult to find a specific cause for this condition. However, in some cases, several factors have been identified. Some people may be affected by more than one of these factors.
| Reason | Description |
|---|---|
| Genes passed down through generations | It has been found that more than 50% of people with this disease inherit it from their genes. This is called familial dilated cardiomyopathy. |
| Coronary artery disease and heart attacks | This condition can be caused by blockage of the blood vessels supplying the heart or damage to the heart muscle due to a heart attack. |
| High blood pressure | Long-term uncontrolled high blood pressure can weaken the heart muscle by forcing the heart to work harder. |
| Viral infections | This condition can be caused by certain types of viruses (e.g. hepatitis, HIV) or infections that affect the heart muscle itself (myocarditis). |
| Excessive alcohol consumption | Excessive alcohol consumption over many years directly damages the heart muscle. |
| Other medical conditions | Conditions such as diabetes, thyroid disease, heart valve disease, and congenital heart disease. |
| Complications during pregnancy | This can occur due to complications that occur during the latter part of pregnancy or after childbirth. |
| Some medications and drugs | Some chemotherapy drugs for cancer and the use of drugs such as cocaine. |
What complications can arise from this condition?
When Dilated Cardiomyopathy becomes more severe, various complications can occur. Some of these can be very serious.
The most important thing is to diagnose the disease and start proper treatment before these complications occur. Then these risks can be greatly reduced.
- Heart Failure: This is the main complication. The heart is unable to pump enough blood to meet the body's needs.
- Arrhythmia: An irregular heartbeat caused by changes in the heart's electrical signaling system.
- Heart valve problems: Due to the enlargement of the heart, the valves in the heart do not close properly and blood starts to leak backward.
- Blood clots: Blood clots can form in the heart due to a decrease in the heart's pumping speed. If this blood clot breaks loose and gets stuck in a vein in the brain, it can cause a stroke , or if it gets stuck in a vein in the lungs, it can cause a dangerous condition called pulmonary embolism .
- Sudden Cardiac Arrest: The sudden cessation of the heart due to a dangerous arrhythmia.
How does the doctor diagnose this disease?
If you have the symptoms mentioned above, the first thing you should do is see your doctor. He or she will ask you about your symptoms, whether anyone in your family has heart disease (family history), and your medical history.
Then, the doctor will examine you. He or she will listen to your chest with a stethoscope to check for fluid in your lungs and to listen for abnormal heart sounds (heart murmurs). The doctor may hear a heart murmur before you have any symptoms.
Tests to confirm the diagnosis
After your physical examination, your doctor will recommend several tests to confirm the disease, understand its severity, and plan the best treatment accordingly.
| Test | What is expected from this? |
|---|---|
| Echocardiogram | This is the most important test. It's like a scan of a baby. It uses sound waves to measure the heart's function, the size of its chambers, and how efficiently it pumps blood. |
| Electrocardiogram (ECG) | A test that records the electrical activity of the heart. It can detect conditions such as arrhythmia. |
| Chest X-ray | You can check to see if the heart is larger than normal and if fluid has accumulated in the lungs. |
| Blood tests | Find out if there is damage to the heart muscle, as well as other causes such as diabetes and thyroid problems. |
| MRI scan of the heart | You can get a very clear picture of the size and function of the heart's chambers. |
| Angiogram | Check for blockages in the coronary arteries that supply blood to the heart. |
What are the treatments for Dilated Cardiomyopathy?
Although there is no cure for this disease, there are very effective treatments that can control symptoms, stop your heart from getting weaker, and help you live longer. The sooner you start treatment, the better the outcome. Treatment can be divided into three main parts.
1. Medicines (types of medicines)
Your doctor may prescribe several medications to improve your heart function, reduce symptoms, and prevent complications.
- ACE inhibitors and ARNI: These widen blood vessels, lower blood pressure, and reduce the workload on the heart.
- Beta-blockers: Control the heart rate, give the heart a rest, and improve heart function in the long term.
- Diuretics: These are also known as "water pills." They help remove excess fluid from the body through urine, reducing swelling and shortness of breath.
- Aldosterone antagonists: These are also a type of diuretic. They help control sodium and fluid in the body.
- Anticoagulants: These medications are given to prevent blood clots in the heart if there is a risk of them forming.
2. Lifestyle changes
Medication alone is not enough. Small changes you can make to your daily life can greatly increase the success of treatment.
- Reduce salt intake: Salt is a major cause of fluid retention in the body. Reducing salt intake in food can help reduce swelling and strain on the heart.
- Avoid alcohol and drugs: Since alcohol directly damages the heart muscle, it is essential to stop it completely or limit it as per the doctor's advice. Drugs like cocaine should be completely avoided.
- Light exercise: You can improve your heart function by engaging in light exercise (e.g. walking) that is appropriate for you and approved by your doctor.
- Heart-healthy foods: Eat more vegetables, fruits, lean meats (chicken, fish), etc. Avoid foods high in oil and sugar.
3. Surgery and other medical procedures
If the disease is in a severe stage and difficult to control with medication alone, the doctor may recommend a method like this.
- Biventricular Pacemaker: A small device that helps the heart's chambers contract at exactly the same time, increasing pumping efficiency.
- ICD (Implantable Cardioverter Defibrillator): A device that detects a dangerous arrhythmia and delivers a small electrical shock to the heart to restore the heart's rhythm.
- LVAD (Left Ventricular Assist Device): A mechanical pump that helps the heart pump. This is usually used temporarily in patients awaiting a heart transplant.
- Heart Transplant: The last option considered for patients in the most severe cases, when all other treatments have failed.
What should you expect when living with this disease?
Your prognosis depends on the cause of the disease, the severity of the disease, and how early you start treatment. With proper treatment and lifestyle changes, most people can live a normal life and continue their work.
However, for some people, symptoms may worsen over time, and they may need to be hospitalized for treatment.
But don't worry. Treatment for this disease is much better now than it was a few years ago. With today's advanced treatments, more than 80% of people with this disease are still living well after 8 years without needing a heart transplant.
How should you take care of yourself?
It is very important for you to take care of yourself on this journey.
- Follow your doctor's instructions: Take your medicine exactly as prescribed, at the right time, and in the right dosage. Don't miss a single day.
- Weigh yourself daily: Weigh yourself at the same time every morning and record your weight. A sudden weight gain in a day or two could mean that you are gaining water weight. If this happens, tell your doctor immediately.
- Attend scheduled clinics: Be sure to go to the clinic on the days the doctor says to come. It is very important to monitor your condition.
- Listen to your body: If you feel your symptoms are getting worse, for example, if you have difficulty breathing or if your legs are swelling, do not ignore it and inform your doctor.
It's normal to feel scared and sad when you learn that you have a heart problem. But remember, you are not alone. With today's treatments, this condition can be managed well. Talk openly with your doctor about any problems or concerns you may have. You and your doctor are on this journey together.
Take-Home Message
- Dilated Cardiomyopathy is a serious condition in which the heart muscle weakens and the heart becomes enlarged.
- Don't ignore symptoms like unexplained fatigue, shortness of breath, and swollen legs.
- This can be influenced by many factors, such as genetic causes, infections, high blood pressure, and lifestyle habits.
- Early diagnosis and treatment can yield very good results.
- Treatment requires medication, lifestyle changes, and sometimes surgery.
- It is essential to follow your doctor's instructions exactly and attend clinics on the scheduled dates.
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