By: Prof. Dr. Seyed Saeid Zamanieh Shahri, MD  and  Prof. Dr. Sonia Sayyedalhosseini, MD

Definition: Dilated cardiomyopathy is a disease of the heart muscle that usually begins in the heart’s main pumping chamber (left ventricle). Under these conditions, the ventricle becomes stretched and thin and cannot pump blood properly. Cardiomyopathy is a general term that also refers to abnormalities of the heart muscle itself. Dilated cardiomyopathy may not cause certain symptoms, but it can be dangerous for some people. Dilated cardiomyopathy can also lead to irregular heartbeats (arrhythmias), blood clots, or sudden death. It affects people of all ages, including infants and children, but is more common in men between the ages of 20 and 50.

Causes of dilated cardiomyopathy:

The cause of dilated cardiomyopathy is often undiagnosed.

However, countless factors can cause left ventricular failure, including:

* Diabetes

* Obesity

* High blood pressure

* Alcohol abuse

* Cancer-specific drugs

* Cocaine abuse

* Complications of pregnancy in late pregnancy

* Exposure to toxins such as lead, mercury and cobalt

* Infections, including infections caused by bacteria, viruses, fungi and parasites

Risk factors for dilated cardiomyopathy:

Dilated cardiomyopathy is more common in men between the ages of 20 and 50, but it is also seen in women.

Other risk factors for this disease are:

* Damage to the heart muscle due to a heart attack

* Family history of dilated cardiomyopathy

* Neuromuscular disorders such as muscular dystrophy

* Inflammation of the heart muscle from immune system disorders such as lupus

Symptoms of dilated cardiomyopathy:

Patients with dilated cardiomyopathy are more likely to experience signs and symptoms of heart failure or arrhythmia.

Signs and symptoms of dilated cardiomyopathy include:

* Fatigue

* Chest pain

* Decreased ability to exercise

* Swelling in the legs, ankles and feet

* Abdominal swelling due to fluid (ascites)

* Shortness of breath

* Excessive or abnormal sounds heard when the heart is beating (heart murmur)

See your doctor as soon as possible if you have shortness of breath or other symptoms of cardiomyopathy. If you have chest pain that lasts for more than a few minutes or you have trouble breathing, go to the emergency room right away. If one of your family members has dilated cardiomyopathy, talk to your doctor about screening other family members to assess the condition. Early detection using genetic testing may be effective for people who are genetically predisposed to the disease and have no obvious symptoms.

Complications of dilated cardiomyopathy:

Complications of dilated cardiomyopathy include:

*Edema: Fluids can accumulate in the lungs, abdomen, and legs.

*Sudden cardiac arrest: Dilated cardiomyopathy can cause sudden cardiac arrest.

*Abnormal heart rate (arrhythmia): Changes in the structure of the heart and changes in pressure in the heart chamber can even exacerbate arthritis.

*Heart failure: Poor blood flow from the left ventricle can lead to heart failure and the heart cannot supply the blood needed by the body to function properly.

*Enlargement of the left ventricle can make it harder for the heart valves to close and cause blood flow to flow backwards.

*Blood clots (embolism): Accumulation of blood (stasis) in the left ventricle can lead to blood clots, which may enter the bloodstream and cut off blood flow to vital organs and cause a stroke. It causes a heart attack or serious damage to other organs as well.

Prevention of dilated cardiomyopathy:

A healthy lifestyle can be effective in preventing or minimizing the side effects of dilated cardiomyopathy.

Some of these solutions are:

* Maintain a healthy weight

* Quit smoking and alcohol

* Regular exercise and adequate sleep and rest

* Do not use cocaine or other similar drugs

* Observing a healthy diet, especially a low-salt (sodium) diet

Diagnosis of dilated cardiomyopathy:

The doctor examines the patient’s personal and family medical history and uses a stethoscope to perform a physical examination to listen to the patient’s heart and lungs, and to provide the necessary tests. It is even possible for the doctor to refer the patient to a cardiologist for testing.

Tests that a doctor can use to diagnose the disease include:

*Blood tests, these tests show the doctor information about the heart, the presence of an infection, metabolic disorder or toxins in the blood that could be the cause of the disease.

*Chest X-ray, Your doctor may order a chest x-ray to check for changes or abnormalities in the structure and size of your heart, and the fluid in or around your lungs.

*An electrocardiogram can show signs of an abnormal heartbeat or left ventricular problems.

*Echocardiogram, the main tool for diagnosing dilated cardiomyopathy, uses sound waves to produce images of the heart and allows the doctor to examine the structure and condition of the left ventricle and the state of blood flow from the heart.

*Exercise stress test. Your doctor may use exercise tests to measure your heart rate and oxygen level. This type of test can show the severity of problems caused by dilated cardiomyopathy.

*CT scan or MRI, in some cases, tests the size and function of the heart cavities.

*Cardiac catheterization, this test allows the doctor to view the coronary arteries on X-rays and measure the pressure in the heart, take a sample of muscle tissue and identify possible damage.

*Genetic screening or counseling if your doctor cannot diagnose the cause of dilated cardiomyopathy, may order screening of other family members for inherited and genetic disease.

Some strategies that can be effective in managing the symptoms of this disease are:

*Maintain a healthy weight: Excess weight makes heart function harder.

* Heart-healthy diet: Eating whole grains and fruits and vegetables and limiting salt, sugar and cholesterol, saturated fats and tran-fats are good for the heart.

* Exercise: Patients should consult their doctor to tell them what activities will be useful for them. In general, competitive sports are not recommended for people with the disease because they can increase the risk of cardiac arrest and cause sudden death.

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