Dilated cardiomyopathyMarian Grosser studied human medicine in Munich, Germany. In addition, the doctor, who is interested in many things, has ventured on several exciting detours: studying philosophy and art history, working in radio and finally for Netdoktor.
The dilated Cardiomyopathy is a special form of heart muscle disease. The left ventricle in particular expands. Affected persons suffer from cardiac arrhythmia. The symptoms of heart failure. Gene mutations are the most common cause. Various environmental factors considered. The disease cannot usually be cured, but the symptoms can be alleviated. Read all about dilated cardiomyopathy here!
Dilated cardiomyopathy: description
Dilated cardiomyopathy (DCM) is a severe disease in which the heart muscles change their structure. It no longer works properly and thus the heart pumps less blood into the systemic circulation during the expulsion phase (systole). In addition, the heart muscle can usually no longer relax properly, so that the phase in which the heart chambers fill with blood (diastole) and have to expand is also disturbed.
This form of cardiomyopathy gets its name because the left ventricle in particular is affectedVentricledilated, i.e extends. If the disease progresses, the right ventricle and atria may also be affected. The walls of the heart can become thinner as they expand.
Who does dilated cardiomyopathy affect??
Dilated cardiomyopathy is the most common Cardiomyopathy. In about 50 percent of cases, the cause of the disease cannot be determined (primary or idiopathic DCM). The remaining dilated cardiomyopathies are a consequence or the end state of various diseases and harmful environmental factors (secondary DCM). Idiopathic DCM is diagnosed annually in Germany in about 6 out of 100 patients.000 people have been diagnosed with this disease. Most patients are between 20 and 40 years old at diagnosis, with men affected about twice as often as women.
Dilated cardiomyopathy: symptoms
Patients with DCM often have the typical symptoms of a weak heart (heart failure). On the one hand, because of its limited performance, the heart is unable to supply the body with sufficient blood and thus oxygen (cyanosis) – doctors refer to this as forward failure.
On the other hand cardiac insufficiency also often associated with reverse failure. That is, blood backs up in those blood vessels that lead to the heart. If the left heart is affected (left heart failure), such blood congestion mainly affects the lungs. If the right ventricle is weakened, blood backs up in the venous vessels coming from all over the body.
Dilated cardiomyopathy initially manifests itself with the symptoms of progressive left heart failure. Patients suffer from:
fatigue and reduced performance. Affected persons often complain of a general feeling of weakness. – shortness of breath during physical exertion (Exertional dyspnea). If the cardiomyopathy is already very advanced, shortness of breath may occur even at rest (resting dyspnea). Fluid accumulation in (pulmonary edema) and around the lung tie (pleural effusion), which can exacerbate shortness of breath. Pulmonary edema may be noticeable due to rales when breathing. Tightness in the chest (angina pectoris). Also this feeling appears mainly with physical exertion.
In the course of the disease, dilated cardiomyopathy often affects the right ventricle as well. In such cases, physicians speak of global insufficiency. In addition to the symptoms of left heart failure, patients then complain of fluid retention (Edema) especially in the legs. In addition, the neck veins are often very prominent because blood also accumulates from the head and neck.
Since the structure of the heart muscle changes in DCM, the electrical generation and transmission of impulses in the heart is also disturbed. Therefore, dilated cardiomyopathy is often associated with cardiac arrhythmias. Those affected occasionally feel this as heart palpitations (palpitations). As the disease progresses, the arrhythmias can become more dangerous. Cause circulatory collapse or – in the worst case – even sudden cardiac death.
Especially the left ventricle dilates in dilated cardiomyopathy. This, in turn, pulls apart the fibrous ring to which the mitral valve is attached. Therefore, there is a risk of mitral valve regurgitation as DCM progresses.
Because of impaired blood flow in the atria and ventricles, blood clots form more easily in dilated cardiomyopathy than in healthy individuals. If such a clot breaks loose, it can enter the arteries with the blood flow and block them. This can lead to serious complications such as Pulmonary infarction or stroke lead.
Dilated cardiomyopathy: causes and risk factors
Dilated cardiomyopathy can cause primary or secondary develop. Primary means it originates directly in and is confined to the heart muscle. In secondary forms, other diseases or external influences are the triggers of DCM. Heart or other organs are then only damaged as a result of these factors.
Primary dilated cardiomyopathy is in some cases genetically determined. In a good quarter of cases, other family members are also affected. Often the Trigger a primary DCM unknown (idiopathic, about 50 percent).
Dilated cardiomyopathy is a form of heart muscle disease that is relatively often caused secondarily. Triggers include, for example:
– Long-term, excessive alcohol consumption and drug use (such as cocaine). Alcohol abuse in particular is considered one of the main risk factors for dilated cardiomyopathy. – Inflammation of the heart muscle (myocarditis), possibly triggered by viruses or bacteria (examples: Chagas disease, Lyme disease). – heart valve defects – autoimmune diseases, such as z.B. Systemic lupus erythematosus (SLE). – Hormone disorders (especially growth and thyroid hormones) – Medications: Certain cancer drugs (cytostatics) can cause dilated heart muscle disease as a rare side effect. – Malnutrition – Radiation therapy to the chest area – Congenital diseases affecting the protein buildup of muscles, e.g.B. muscular dystrophies. – Environmental toxins: Heavy metals in particular, such as lead or mercury, accumulate in the heart muscle and disrupt cell metabolism. – Coronary artery disease (CAD). In affected individuals, the heart muscle permanently receives too little oxygen and therefore changes its structure (ischemic cardiomyopathy). The culprit is a narrowing of the coronary arteries. – In very rare cases, dilated cardiomyopathy occurs during pregnancy. However, the correlations here are still unclear.
According to newer definitions, only cardiomyopathies that are not a direct consequence of other cardiovascular diseases belong to the cardiomyopathies. Accordingly, ischemic cardiomyopathy does not belong to the group of dilated cardiomyopathies. In some textbooks, however, it is still considered a secondary DCM.
Dilated cardiomyopathy: examinations and diagnosis
First, the physician asks the patient about his Medical history (medical history). He is particularly interested in what symptoms the patient has, when they occur, and how long they have existed. It is also important to know whether the patient drinks a lot of alcohol, takes other drugs or has any pre-existing conditions.
The interview is followed by thephysical examination at. Some signs of heart failure can be seen by the doctor with the naked eye. For example, the skin of those affected often appears bluish (cyanosis) due to the chronic lack of oxygen. Pulmonary edema may be noticeable as a rhonchi sound when listening to the lungs.
Many heart muscle diseases show similar symptoms. To determine exactly what type of cardiomyopathy is present, special diagnostics and medical equipment support are required. The most important tests are:
Cardiac ultrasound (Echocardiography): in DCM, the most noticeable feature is the dilated left heart. The heart walls may be thinner than normal and move erratically. Especially in advanced dilated cardiomyopathy, the physician measures reduced ejection fraction (EF). Electrocardiogram (ECG): Many DCM patients have a specific disturbance of the electrical activity of the heart in the ECG, which is called left bundle branch block. X-ray-Chest x-ray: Because of the enlarged left ventricle, the heart appears enlarged on x-rays (cardiomegaly). Pulmonary congestion can also be detected. Cardiac catheterization. The coronary vessels can be examined as part of this method (coronary angiography). Taking tie samples from the heart muscle (myocardial biopsy). Fine tie examination under the microscope enables a reliable diagnosis to be made.
There are also certain blood levels that may be elevated in association with DCM. However, these findings are hardly specific, but occur in many cardiac and also other diseases. For example high BNP concentrations Generally indicative of heart failure.