Dilated Cardiomyopathy

Treatment Overview

In most cases, treatment for dilated cardiomyopathy is done to relieve symptoms, improve heart function, and help you live longer. The majority of people will need to take a number of medications along with making healthy lifestyle changes. Surgical procedures may also be considered, especially when medications do not improve your condition.

In some cases the underlying cause of the condition can be successfully addressed, such as when dilated cardiomyopathy is caused by excessive alcohol consumption. Limiting how much you drink may help prevent the disease from progressing.

However, in viral myocarditis (inflammation of the heart muscle caused by a virus), there are no medications to attack the viruses that cause dilated cardiomyopathy.

Medications

Medications used to treat heart failure caused by dilated cardiomyopathy include:

• Angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and vasodilators, which widen blood vessels to improve blood flow and reduce the heart's workload. ACE inhibitors are considered the basis of therapy for dilated cardiomyopathy. They specifically have been shown to improve symptoms and prolong life in people who have heart failure.¹ ARBs may be used when a person cannot tolerate ACE inhibitors or the medication is not controlling symptoms. Other vasodilators may be used when a person cannot tolerate ACE inhibitors or ARBS, or the medications are not controlling symptoms.
• Beta-blockers, which slow the heart rate and reduce blood pressure. The heart can pump more efficiently when it has more time to relax. Carvedilol and metoprolol are beta-blockers that are currently approved for the treatment of heart failure. Studies show that adding beta-blockers to standard treatment with ACE inhibitors may reduce the rate of hospitalization or death in people with moderate or severe heart failure.¹
• Diuretics, to help remove excess fluid from the body. Spironolactone is a diuretic that prevents potassium loss and has been shown to prolong life in people with severe forms of heart failure.
• Inotropics, such as digoxin or digitoxin. These can help increase the strength of the heart muscle contraction, improve blood flow, and reduce symptoms of heart failure.
• Anticoagulants, such as warfarin (for example, Coumadin) and heparin, to prevent blood clots that can develop when blood is not being pumped efficiently through the heart and out to the rest of the body. Blood clots may lead to strokes or heart attack. People with both dilated cardiomyopathy and atrial fibrillation are at higher risk for developing blood clots.
• Antiarrhythmics, such as amiodarone, which control the heart rate when abnormal, rapid heartbeats (arrhythmias) are present.

For more information on these medications, see the topic Heart Failure.

Surgery

A pacemaker may be surgically placed in the upper chest to control potentially life-threatening abnormal heart rhythms (arrhythmias). Biventricular pacemakers are used in people who have heart failure and problems with the heart's electrical system. A biventricular pacemaker helps the heart beat regularly by making the lower chambers (ventricles) contract together.

Implantable cardioverter defibrillators (ICDs) are recommended for people at risk of ventricular tachycardia (VT, V tach), a life-threatening arrhythmia, or cardiac arrest. A recent study suggests that cardiac-resynchronization therapy, which uses a pacemaker and sometimes an ICD to stimulate the heart and restore normal rhythm and function, reduces the chance of death in people with heart failure or dilated cardiomyopathy.^{2, 3}

Left ventricular assist devices (LVADs) are mechanical pumping devices that are inserted into the chest to help the heart pump more blood. LVADs may be used to keep people alive until a donor heart is available for transplant (bridge treatment). LVADs may also be used as an alternative to heart transplant for long-term treatment of severe heart failure. These devices require surgery to place the device and to make the connections between the heart and the device. See an illustration of a ventricular assist device.

A heart transplant is the only cure for dilated cardiomyopathy. But a transplant is available to a small number of people who meet specific criteria for transplantation. The diseased heart is removed and replaced with a healthy heart donated by a person who has recently died. There are limited donor hearts available.

Experimental surgical procedures also may be considered for people with dilated cardiomyopathy, especially for those who cannot quickly receive a heart transplant and have no other treatment options. Surgical procedures that are not considered standard practice include:

• Surgical ventricular restoration (SVR). With SVR, portions of the heart that have been weakened and damaged by a heart attack are surgically removed to help the heart pump more effectively.
• Mitral valve repair or replacement. This surgery is standard practice for mitral valve problems, but not for dilated cardiomyopathy. Sometimes, dilated cardiomyopathy can lead to mitral valve regurgitation. Surgery on the mitral valve can treat the regurgitation, but it does not cure dilated cardiomyopathy.

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Author:	Robin Parks, MS	Last Updated: August 30, 2006
Medical Review:	Kathleen Romito, MD - Family Medicine E. Gregory Thompson, MD - Internal Medicine Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
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