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Dilated cardiomyopathy is a fairly common cardiovascular disease in clinical practice and a common cause of heart failure. So is dilated cardiomyopathy dangerous and how to diagnose and treat this pathology to limit complications and reduce patient mortality?
1. What is dilated cardiomyopathy?
1.1 Definition Dilated Cardiomyopathy (DCM) is a cardiomyopathy characterized by enlargement and dilation of one or both ventricles with normal left ventricular wall thickness, along with impaired capacity contractility was defined as a left ventricular ejection fraction (LVEF) less than 40%.
By definition, the patient has systolic dysfunction and may or may not have obvious symptoms of heart failure. This pathology can be classified as primary or secondary dilated cardiomyopathy. Primary dilated cardiomyopathy is considered idiopathic and the diagnosis can only be made after ruling out secondary causes.
1.2. Epidemiology It is estimated at 1 in 2,500 people. Genetic inheritance occurs in 35% of patients. Dilated cardiomyopathy most commonly occurs in adults aged 20-60 years, but children can also be affected. More common in men than women. Some genotypes occur more frequently in African-Americans than in Caucasians.
2. Causes and risk factors of dilated cardiomyopathy
Family history of dilated cardiomyopathy, heart failure, or sudden cardiac arrest. Myocarditis due to immune system disorders, such as systemic lupus erythematosus and rheumatoid arthritis... Neuromuscular disorders, eg muscular dystrophy . Certain infections Complications of the third trimester of pregnancy. Diabetes. Hemoglobin disease. Heart rhythm problems such as arrhythmias. Hypertension. Fat . Heart valve disease, such as mitral regurgitation or aortic regurgitation. Abuse of alcohol. Exposure to toxins, such as lead, mercury, and cobalt. Use of certain drugs to treat cancer. Using illegal drugs such as Amphetamine or Cocaine.
3. Diagnosis
3.1. Clinical Symptoms Fatigue. Shortness of breath, shortness of breath when active or sometimes lying down. Reduced ability to function. Swelling in the legs, ankles, feet or abdomen, weight gain, increased abdominal circumference. Distended neck veins. Dizziness, fainting. Pain or discomfort in the chest. Tachycardia and palpitations. 2.2. Subclinical X-ray of the lungs: Cardiac enlargement, pulmonary edema. Electrocardiogram: May show only sinus tachycardia or bradycardia, left bundle branch block, or ST and T wave changes. Echocardiography: Marked dilation of the left ventricular cavity and decreased systolic and diastolic function. There may also be manifestations of mitral regurgitation, tricuspid regurgitation. Class B Diuretic Peptide (BNP): Can be used clinically in the diagnosis, management, and prognosis of patients, especially those with heart failure. Coronary angiogram: Usually shows a normal pulse. Endocardial Biopsy: Biopsy exposes the patient to unnecessary risks and should only be performed to rule out specific myocardial disorders, eg myocarditis, Amyloidosis, Sarcoidosis or Haemochromatosis.
4. Can dilated cardiomyopathy be cured?
Currently, dilated cardiomyopathy can be treated with a combination of different methods and brings many positive results. Treatment for dilated cardiomyopathy is primarily aimed at improving heart function, treating symptoms, and preventing complications. Therefore, the treatment is the same as that of heart failure.
Loop diuretics and thiazide diuretics: For all patients with symptoms of fluid overload. ACE inhibitors: Used in patients with reduced left ventricular ejection fraction. Angiotensin II receptor antagonists may be used instead. ACE inhibitors and beta blockers improve function even when the patient is asymptomatic. Digoxin: For patients who have not responded adequately to ACE inhibitors and diuretics, or possibly for patients with atrial fibrillation and ventricular tachycardia. Beta-blockers: Indicated for all patients because they have been shown to reduce morbidity and mortality. Spironolactone: Also shown to reduce morbidity and mortality. Nitrates: Used for patients with diastolic dysfunction and pulmonary obstruction. Anticoagulation: For patients with atrial fibrillation, prosthetic heart valves or septal thrombosis. Implantable defibrillators: Reduces risk of sudden death in high-risk patients. Mitral ligation surgery or valve replacement may improve symptoms in patients with severe regurgitation due to severe mitral regurgitation. In patients with recurrent ventricular tachycardia, catheter ablation may be beneficial. Medical therapies may not be responsive in some patients, especially in young people, so a heart transplant or left ventricular assist devices may be required. Stem cell therapy improves left ventricular ejection fraction and decreases end-systolic left ventricular volume and left ventricular end-diastolic chamber size in patients with dilated cardiomyopathy. More research is needed on the effects of stem cell therapy in this group of patients.
5. Is dilated cardiomyopathy dangerous?
5.1. Complications of dilated cardiomyopathy: Heart failure is the ultimate and dangerous complication of dilated cardiomyopathy. If not treated early and properly, heart failure can be life-threatening. Leaky heart valves (reflux heart valves): Dilated cardiomyopathy can make it harder for the heart valves to close. Blood can leak back through the heart valves, which is worse if the patient has had mitral regurgitation in the past. Irregular heartbeat (arrhythmia): Changes in the size and shape of the heart can interfere with the heartbeat. Sudden cardiac arrest: Dilated cardiomyopathy can cause the heart to stop beating suddenly. Pulmonary hypertension, diastolic dysfunction. Blood clot formation: Blood pooling in the left chamber of the heart (left ventricle) can lead to blood clots. If clots enter the bloodstream, they can block blood flow to other organs, including the heart and brain. Blood clots can cause a stroke, heart attack, or damage to other organs. Heart rhythm disturbances such as atrial fibrillation can also cause blood clots. 5.2. How long does dilated cardiomyopathy last? Prognosis is related to the severity of the initial presentation. In addition, factors such as fluid and salt restriction, medication adherence, and exercise may also influence prognosis. The survival rate for patients with dilated cardiomyopathy after the first year is 80%, which decreases by 10% each year. The 5-year survival rate for patients with dilated cardiomyopathy is about 50%. Mitral regurgitation or diastolic dysfunction is associated with a worse prognosis. Approximately 40 to 50% of patients die suddenly from malignant arrhythmias or thromboembolic events. Congenital cardiomyopathy is associated with high morbidity and mortality. Patients with dilated cardiomyopathy should receive education about prevention and cardiac rehabilitation as this has been shown to reduce all-cause mortality by 20-30% over 5 years, including including the improvement of symptoms. One study of patients with dilated cardiomyopathy treated with heart transplantation had survival rates of 91% at 1 year, 80% at 5 years, and 50% at 20 years. In summary, dilated cardiomyopathy is a cardiovascular disease with dangerous complications and can lead to death. Patients and family members should have regular health checks and consult a cardiologist for early diagnosis and treatment. This helps to limit the complications of the disease, and at the same time helps to prolong the life of the patient.
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