Dilated cardiomyopathy( DCM) is a pathology of the myocardium, which is characterized by dilatation( dilatation) of the ventricular cavity, without increasing the thickness of their walls. Against the background of the disease, the contractility of the heart worsens, signs of congestive heart failure develop, thromboembolism progresses, heart rhythm is disrupted. The risk of a sudden fatal outcome in dilated cardiomyopathy is very high, so the therapy includes an extensive list of medicines.
Features of the disease
The most susceptible to the development of this disease are men. According to statistics, they have 2-3 times more dilated cardiopathy than women. The first clinical manifestations may appear as early as 20 years, but they also reveal it in the elderly and children. Due to the absence of single diagnostic criteria, the frequency of the disease among them has not been determined. It is noted that in children, DCMP is detected in 10 cases per 100 000 population.
At the initial stages, the disease can be fully compensated by the body, which makes it difficult to detect it early. Clinical symptoms appear as the resources and reserves of the heart are depleted. In 60% of cases, thrombi form in its cavity, which subsequently can clog vessels in the large circulation or pulmonary artery, causing a fatal outcome.
Dilated cardiomyopathy has its own classification, which we will discuss below.
Classification and forms of
Dilated cardiomyopathy is divided into forms depending on the etiology. Allocate:
- Primary dilated cardiomyopathy or idiopathic form( the cause of the occurrence is unknown).
- Secondary DCMP;
Primary forms of the disease develop due to unknown causes. The secondary appears on the background of the development of numerous provoking factors and pathologies. This includes some diseases that, in the absence of treatment, increase the stretching of the heart muscle: endocrine disorders, infections, arrhythmias. These factors are often combined with a hereditary predisposition and a fall in the body's immune forces.
About what the dilated cardiomyopathy is in the early stages, the video below will show:
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Causes of
For a long time, specialists could not determine the causes of dilated cardiomyopathy. Now there are several assumptions that may be a risk factor for the development of this pathology. This includes:
- Heredity. It was found that 30% of the patients had relatives who also had DCMP.Such family forms of the disease have the worst prognosis. The development of pathology begins because of Bart's syndrome, which is characterized by a number of cardiac disorders.
- Toxic causes. Another 30% of patients with diagnosed DCMD abused alcohol. To toxic causes of development can also be attributed to contact with aerosols, metals, any poisonous materials.
- Autoimmune disorders. In this case, the causes of the appearance of pathology lie in the presence of cardiac autoantibodies. But until now, factors that provoke their appearance in the body have not been established.
- Metabolic causes are nutrition with insufficient amounts of nutrients. This includes, in particular, the lack of carnitine, vitamins, especially group B, selenium, as well as a deficit of protein.
- The viral theory of the origin of DCM is confirmed by the detection in the patient of not only viral myocarditis, but also a number of other viruses( herpes, adenovirus, cytomegalovirus, etc.).
It is not always possible to recognize the cause of dilated cardiomyopathy. However, it is assumed that its development begins when there are a number of provoking endogenous and exogenous factors.
Symptoms of
The development of DCM is gradual, so there may be no clinical manifestations for a long time. Subacute illness manifests rarely, after a cold or pneumonia
- Swelling of the legs;
- Rapid fatigue;
- Irregular heart beat;
- Shortness of breath, which appears at the beginning with loads, and after and at rest;
- Feeling of heaviness in the right side due to enlarged liver;
- Orthopnea( shortness of breath in prone position);
- Ascites( accumulation of fluid in the abdominal cavity);
- Dry cough.
Fainting, irregular heartbeat, dizziness - these symptoms are observed in conduction disorders and heart rhythm. It also happens that cardiac manifestations are absent for a long time, and afterwards they claim an ischemic stroke caused by thromboembolic arteries. The risk of embolism is increased if cardiomyopathy is accompanied by atrial fibrillation.
Now that you know about the pathogenesis, pogovrim and about the criteria for diagnosing dilated cardiomyopathy.
Diagnostics
There are no specific criteria for the disease, which makes diagnostics an order of magnitude more difficult. Most often, the diagnosis of DCM is established by excluding other cardiac pathologies, which may be accompanied by circulatory insufficiency and stretching of the cavities of the heart muscle. In addition, the presence of objective signs of cardiomyopathy is established: insufficiency of tricuspid and mitral valves, cervical vein swelling, tachycardia, wheezing in the lungs, cardiomegaly, enlarged BH and liver.
Diagnostics includes a number of activities:
- Scintigraphy. Helps to rule out IHD, also used to detect myocarditis.
- Biopsy. It does not apply to mandatory diagnostic methods, it is used only if there are suspicions of rejection of the implant.
- ECG helps to detect type of atrial fibrillation, rhythm disturbance, hypertrophy or excessive left ventricular congestion, AB blockade, atrial fibrillation.
- Holter monitoring is one type of ECG study that is carried out throughout the day to reveal the dynamics of repolarization during this period.
- Radiography shows how much the heart has increased, whether there are stagnant phenomena in the lungs.
- With the help of echocardiography, a decrease in the ejection fraction and an increase in the heart cavities, a decrease in contractility, as well as clots are detected. This is the main method of research, as it helps to exclude other causes characteristic of the development of heart failure - heart disease, cardiosclerosis, etc. Echocardiography reveals the risk of developing thromboembolism.
MRI, radionuclide ventriculography, coronary cardiography, angiography of vessels, cardiac catheterization, spiral CT are used as additional survey methods.
Next, we'll talk about what treatment standards involves dilated cardiomyopathy.
The following video will describe the symptoms and signs of the problem, as well as the methods of treatment of dilated cardiomyopathy:
Treatment
Therapeutic
It is impossible to influence effectively the causes that lead to the development of dilated cardiomyopathy, so the course of therapy is aimed at preventing the development of complications. To prevent the onset of heart failure, the patient should maintain a diet. Nutrition in dilated cardiomyopathy requires limiting the use of water( not more than 1.5 liters) and salt( no more than 3 g).The same treatment includes physical exercises, individually selected.
In case of rhythm disturbances, symptomatic therapy is performed. It is important to remember that dilated cardiomyopathy does not involve treatment with folk remedies.
Medication
Like all therapy, it prevents complications. To prevent heart failure appoint:
- Diuretics for removing excess salt and liquid.
- Beta-blockers. They reduce the heart rate, prevent arrhythmia and prevent the increase in blood pressure.
- ACE inhibitors are used in combination with previous drugs. They slow the progression of heart failure of the chronic course, reduce the possibility of damage to the heart muscle and other internal organs. Thanks to such therapy, the life of patients is prolonged.
- Cardiac glycosides are prescribed in the presence of atrial fibrillation, which occurs against the background of reduced cardiac contractility.
- With advanced heart failure, receptor antagonists for aldosterone are indicated.
Mandatory treatment with medication involves the prevention of thromboembolism. For this purpose, the patient is prescribed disaggregants that prevent the adhesion of platelets. With significant contraindications, anticoagulants are selected, which also worsen blood coagulability. They are necessary both to prevent the formation of clots, and to resolve the already existing thrombi.
Thrombolytic therapy is initially performed in a direct way, that is, by direct administration of anticoagulants intravenously. The duration of such treatment is 6 months, after which indirect anticoagulants are prescribed to prevent recurrent thromboembolism.
Surgical and Electrophysiological
- Resynchronizing therapy helps restore conduction within the heart muscle. The electrostimulator in patients with non-simultaneous contraction of the ventricles aligns the rhythm, helps maintain their contractility and improves blood flow. It is advisable to establish it at the initial stages of the disease in order to prevent the development of serious complications.
- Dynamic cardiomyoplasty, in which the heart is wrapped around its own dorsal muscle, improves the quality of life of the patient, as it improves the tolerance of the load and eliminates the need for frequent hospitalizations and medication. However, this type of surgery does not affect the survival of patients, increasing it only slightly.
- The implantation of the non-cardiac skeleton from special twisted strands occurs in the region of the ventricles and atria. Such a mesh is elastic and manufactured individually. Gradually decreases the volume of the ventricles and simultaneously increases the strength of the heart muscle. However, at the moment there is no data on the remote impact of the operation.
- Valve replacement is carried out in cases where the own valve in the heart is not able to restrain the reverse flow of blood. Implant as special pumps that help the muscle to pump blood into the aorta. After the intervention there is an improvement in the load tolerance, and the life span is also increased. But in this case there is a risk of complications in the form of thromboembolism and infection.
- Heart transplantation is one of the most radical and effective methods of treatment of DCM.Survival after transplantation is 85%.
Prevention of the disease
At the moment there are no effective actions that will accurately help prevent the development of cardiomyopathy. You can only prevent the emergence of secondary dilated cardiomyopathy, following all the recommendations of doctors. Obligatory exclusion is due to bad habits in the form of smoking and drinking alcohol.
Survey of close relatives after revealing the patient's cardiomyopathy helps to determine the disease at the earliest stages. Timely high-grade treatment prevents the development of complications, while also increasing the life span. This is also facilitated by clinical examination and planned visits to the cardiologist.
And now let's talk about the causes of sudden death in people whose medical history included dilated cardiomyopathy.
Causes of sudden death in dilated cardiomyopathy
Lethal outcome can occur suddenly in 50% of cases. The most common cause of this is a severe pathology of the heart rhythm, fibrillation, as well as thromboembolism. The remaining patients die as a result of the gradual development of heart failure.
Complications of
Among complications developing with dilated cardiomyopathy, there are:
- Heart conduction disorders.
- Thromboembolism, in which a thrombus forms in the cavity of the vessel or on its wall. Subsequently, it breaks off and blocks its lumen.
- Chronic heart failure, in which there is insufficient blood flow to the internal organs.
- Heart rhythm disturbances.
On how the prognosis for dilated cardiomyopathy awaits you, if you follow the recommendations of the doctor, read at last.
Forecast
Statistics show that in the next 5 years, 70% of patients die from death. If the cardiac wall is thinning, the heart is worse functioning, against which the prognosis worsens. Negative impact on him and the development of violations of the heart rate. Compared to women, in men, life expectancy at dilated cardiomyopathy is halved.
Heart transplantation improves the prognosis several times. From 85% to 90% of people who underwent heart transplant, live for about 10 years. Several improve the prognosis helps strict adherence to doctor's recommendations, rejection of bad habits. But the forecast as a whole remains unfavorable.
More details about the peculiarities of such ailment as dilated cardiomyopathy will tell the following video: