Is your heart weak and enlarged? Let's talk about Dilated Cardiomyopathy!

Our heart is truly an amazing organ, isn't it? How much do we care about this heart that constantly gives life to our entire body? Sometimes, without us even realizing it, this heart can also develop various problems and diseases. Today we are going to talk about a disease that weakens the heart and causes the heart muscle to enlarge unnecessarily, a disease that has a somewhat scary name, but is very important for all of us to be aware of. This is what doctors call (Dilated Cardiomyopathy).

What is Dilated Cardiomyopathy?

Simply put, this condition (Dilated Cardiomyopathy) is when the main pumping chamber of your heart, the left ventricle , or the main muscle of the heart, stretches and becomes larger than normal. Think of it like a rubber band stretching, but in this case, it's not good for the heart. When the heart muscle weakens, thins, and enlarges, the heart's ability to pump blood properly decreases. What happens then? Each time the heart beats, a little blood is left inside the heart. As a result, the rest of the body does not get the right amount of oxygen-rich blood. In severe cases, this can affect other parts of the heart as well.

Researchers estimate that about 36 out of 100,000 people in the general population suffer from this condition. But the good news is that there are treatments for this heart disease. And there are things you can do to manage the condition.

What are the symptoms of this disease?

Many people, especially in the early stages of the disease, may not show any symptoms. That's the scary part of this disease. But as the heart function gradually worsens, you start to feel more and more symptoms.

Symptoms of Dilated Cardiomyopathy may include:

• Chest pain or tightness
• Cough and congestion
• Dizziness or lightheadedness
• Fainting
• Feeling unusually tired ( Fatigue )
• Palpitations or fluttering in your chest
• Shortness of breath / dyspnea
• Swelling/edema of the abdomen, legs, ankles, and feet
• Unexpected weight gain from fluid retention

If you have one or more of these symptoms, it is very important to seek medical advice immediately.

Why does this (Dilated Cardiomyopathy) occur?

"Why on earth did this happen to me?" you may be wondering. In fact, in many cases, even experts can't pinpoint the exact cause. However, there are some known causes. They are:

• Abnormal heartbeat (rhythm problems) ( Arrhythmia )
• Alcohol use disorder
• Some anti-cancer drugs (these can be harmful to the heart - cardiotoxic drugs)
• Complications that occur late in pregnancy or after childbirth
• Congenital heart disease
• Coronary artery disease
• Diabetes
• Conditions inherited from parents through genes (this is called familial dilated cardiomyopathy . This may account for more than 50% of cases)
• Heart attack
• Heart valve disease
• High blood pressure
• HIV infection
• Infections such as inflammation of the heart muscle (for example, myocarditis )
• Use of drugs such as cocaine
• Thyroid disease
• Viral hepatitis

Sometimes a person can have more than one cause. For example, you may develop Dilated Cardiomyopathy due to another medical condition, while you may be genetically predisposed.

Who is most at risk of developing this disease?

Some people are more likely to develop this condition than others. They are:

• People under 50 years old
• People of black descent (although this is not particularly relevant to Sri Lanka, it is something that is seen globally)
• Male individuals
• If someone in the family has Dilated Cardiomyopathy (genetic influence)

What are the possible complications of Dilated Cardiomyopathy?

If this disease progresses, that is, in the final stages, various complications can occur. These are quite serious, which is why it is important to seek treatment quickly.

These complications may include:

• Abnormal heartbeat ( Arrhythmia )
• Chest pain ( Angina )
• Blood clots in the heart (these blood clots can travel to the lungs and cause a dangerous condition called pulmonary embolism )
• Cardiac arrest
• Heart attack
• Heart failure - This means that the heart is so weak that it cannot meet the body's needs.
• Heart valve disease
• Stroke

Just think about how serious these complications are. That's why you should be concerned if you notice even the slightest symptom.

How do doctors diagnose this disease (Dilated Cardiomyopathy)?

When you see a doctor, he or she will first ask about your medical history (such as previous illnesses you have had, medications you take, etc.) and family history (such as illnesses in your family). Then they will do a physical exam . During this time, the doctor will listen to your lungs to check for fluid buildup. Surprisingly, a doctor may hear an abnormal sound in your heart (a heart murmur) before you have any symptoms.

After that, you will need to undergo various tests to determine the exact severity of the disease and plan the treatment that is right for you.

What tests are done for this?

Typically, tests like these can be done:

• Angiogram: This checks to see if there is any blockage in the coronary arteries that supply blood to your heart.
• Blood tests: These check for heart damage and other problems.
• Chest X-ray: This can give a rough idea of ​​whether your heart is larger than normal.
• Echocardiogram: This is a very important test. It's like a 'video' of the heart. It can show how well the heart is working, how the muscles are, and how the valves are working.
• Electrocardiogram (EKG/ECG): This checks the electrical activity of the heart, meaning whether there are any problems with the rhythm of the heartbeat.
• Exercise stress test: This tests how your heart responds when you exercise.
• Genetic testing: This test helps determine if you have a genetic predisposition to the disease.
• Heart MRI: This can also provide a clear picture of the size and function of the heart's chambers.
• Endomyocardial biopsy: This is not done very often. It involves taking a small sample of the heart muscle and examining it.

How is Dilated Cardiomyopathy treated?

You may need different types of treatment. Although these treatments often cannot completely cure the disease, they can help control symptoms and help you live a healthier, longer life. The sooner treatment starts, the better the outcome. Your cardiologist or heart failure specialist will talk to you and decide on the best treatment plan for you.

Treatment methods can be divided into three main categories: medications, lifestyle changes, and surgery or other medical procedures.

Medicines

There are several types of medications that can improve the function of your heart in cases of Dilated Cardiomyopathy. Some examples are:

• ACE inhibitors
• Aldosterone antagonists
• Angiotensin receptor/neprilysin inhibitors (ARNI)
• Antiarrhythmics (medicines for irregular heartbeats)
• Beta-blockers
• Blood thinners/anticoagulants - especially for people with conditions like atrial fibrillation
• Medicines that reduce the amount of unnecessary fluid in the body ( Diuretics )

It is very important to take all of these medications as prescribed by your doctor, in the correct dosage, and at the correct time.

Changes in daily habits

By making small changes to your daily routine, diet, and other things, you can make your medications work better, and perhaps even delay or avoid the need for surgery altogether.

These changes are:

• Protect your body: Limit the amount of alcohol you drink. Avoid illegal drugs completely. Protect yourself from infections like viral hepatitis and HIV.
• Eat a heart-healthy diet: Eat plenty of lean meats (such as chicken and fish), fruits, and vegetables. Eating a diet low in salt can help reduce fluid retention in the body, which can put a strain on the heart.
• Increase physical activity: Gentle exercises that are not too hard on the heart can help improve heart function. Talk to your doctor about what exercises are right for you. You may also want to consider participating in a cardiac rehabilitation program . This is a good place to start exercising safely.

Surgery and minimally invasive procedures

If the disease is more advanced and the heart's function is significantly reduced, you may need surgery or other specialized medical procedures. Some of the procedures for Dilated Cardiomyopathy are:

• Biventricular pacemaker: This is a device that helps the chambers of the heart to function in a consistent rhythm.
• Implantable cardioverter defibrillator (ICD): If your heartbeat becomes dangerously irregular, this device delivers a small electrical shock to restore your heart rate.
• Heart failure or heart valve surgeries: These improve the function of the heart.
• Left ventricular assist device (LVAD): This is a mechanical device that helps pump blood to a severely weakened heart muscle.
• Heart transplant: This is a very rare option, considered when all other treatments have failed.

Can this disease be prevented?

To be honest, this condition is not always preventable. It may run in your family (genetics). Or it may develop as a side effect of treatment for a disease such as cancer, such as chemotherapy .

However, there are things you can do to reduce your risk of developing Dilated Cardiomyopathy:

• Avoid drugs like cocaine completely.
• If you drink alcohol, reduce it to very limited amounts.
• If you have diseases like diabetes or high blood pressure, control them well.
• Take good care of your heart to prevent a heart attack (good diet, exercise, and avoiding smoking).

What can you expect when living with a condition called Dilated Cardiomyopathy?

Your prognosis depends on the cause and severity of your condition. With regular medical care, you may be able to return to work and resume your normal daily activities. However, sometimes your symptoms may get worse over time. If your condition worsens or complications develop, you may have a hard time coping. You may need to stay in the hospital until your symptoms improve.

For many people, dilated cardiomyopathy can worsen over time and lead to long-term heart failure. This means that the heart becomes so weak that it cannot keep up with the body's demands. Kidney failure and severe heart failure are signs that the disease is not going to go well. People who have symptoms even at rest, or who are unable to do any physical activity, often have the worst outcomes.

But don't worry! The health and life expectancy of people with Dilated Cardiomyopathy have improved significantly in recent years. This is due to improved treatments and early detection. Today, more than 80% of people with this disease live well for eight years, without needing a heart transplant.

How do I take care of myself?

The most important thing you can do while living with this disease is to take care of yourself. Follow your doctor's instructions carefully.

• Be on the lookout for signs of complications, such as sudden weight gain, every day.
• Make the changes your doctor recommends (e.g., eating a low-salt diet) exactly.
• See your doctor for follow-up visits several times a year.
• Take the prescribed medication exactly and on time.

When should I see my doctor?

Because your condition can change over time, it's best to stay in touch with your doctor and have regular checkups. This is something you should do throughout your life. If you feel your symptoms are getting worse, talk to your doctor right away. He or she can help you manage your symptoms.

What questions should I ask my doctor?

When you're newly diagnosed with a disease, it's normal to have a lot of questions. Don't hesitate to ask your doctor questions like:

• Is it a good idea to get genetic testing for the rest of my family?
• Should I avoid strenuous work?
• Is there a support group I can join, either in Sri Lanka or online?
• What diet is right for me?
• What kind of exercise should I do and how long should I do it?

No one wants to know that their heart is not working properly. However, today's doctors can offer a variety of treatments to help your heart function properly in conditions like Dilated Cardiomyopathy. There are also simple changes you can make to improve your condition. Don't be afraid to ask questions and understand your options. You can work with your doctor to find the best way forward with this condition.

Important things to remember (Take-Home Message)

I hope you now have a better understanding of the heart muscle disease we talked about today (Dilated Cardiomyopathy) . Although this is a serious condition, if you are aware of it and manage it properly, you can live a good life.

The most important thing is to be aware of the symptoms, seek medical advice promptly, and follow the treatment and instructions given by your doctor exactly. You are not alone, there are doctors and health workers to help and guide you on this journey. So stay strong and face this situation.

` Heart disease, enlarged heart, dilated cardiomyopathy, weakening of the heart muscle, shortness of breath, heart failure, heart treatment