- Myocardium: The myocardium is the thick, muscular layer of the heart that contracts and squeezes the blood out of the heart. It is the myocardium that is affected by cardiomyopathy.
- Pericardium: The pericardium is a thin, double layer that forms a protective sac around the outside of the heart. It contains a small amount of fluid - called pericardial fluid - which acts as a lubricant when the heart is contracting.
- Autoimmune disease: The body's immune system is responsible for defending the body against infection - for example, against viruses and bacteria. Sometimes the immune system breaks down and starts to attack the body's own tissues. This is called auto-immune disease. Some people who are diagnosed with dilated cardiomyopathy appear to have this condition.
- Exposure to toxins (or poisons) or certain medicines: In very rare cases, exposure to certain toxins can cause dilated cardiomyopathy. In these cases, we do not know if the person developed the condition because they already had genetic tendency to develop it or whether toxin caused the cardiomyopathy. Some of the anticancer medicines may cause dilated cardiomyopathy.
- In about 1 in every 1500 to 1 in every 15,000 pregnancies, the woman can develop dilated cardiomyopathy. It can occur from mid to late pregnancy or soon after delivery and is known as peripartum cardiomyopathy. It is possible that, in these circumstances, the woman may already have had dilated cardiomyopathy but it had not been diagnosed. For most women, the dilated heart returns to normal within six to eight weeks of the delivery, provided she gets the appropriate treatment. However, it is possible that the condition could develop again in subsequent pregnancies.
- Swelling of the lower extremities.
- Weight gain.
- Fainting (caused by conditions such as irregular heart rhythms, abnormal responses of the blood vessels during exercise, or no cause may be found).
- Palpitations (fluttering in the chest due to abnormal heart rhythms).
- Dizziness or lightheadedness.
- Blood clots due to blood flowing more slowly through the body. If a blood clot breaks off, it can be carried to the lungs (pulmonary emboli), kidney (renal emboli), brain (cerebral emboli or stroke), or limbs (peripheral emboli).
- Chest pain or pressure (occurs usually with exercise or physical activity, but can also occur with rest or after meals).
- An electrocardiogram (ECG): This is the most basic test. It involves taping electrical leads onto your legs, arms and chest and taking readings of the electrical activity of your heart.
- An echocardiogram: This test uses ultrasound waves to look at the structure of the heart. It produces a picture of the heart and allows doctors to measure the size of the chambers of the heart and how thick the heart muscle is and how well it is working. It also looks at the heart valves and can show if there is any regurgitation. Additional equipment, called Doppler ultrasound, can produce a color image of blood flow within the heart and provide information on how well the heart is working.
- Exercise testing: This test is the same as the ECG described above, but is recorded before, during and after a period of time spent exercising on a treadmill or an exercise bike. This allows the doctor to examine any changes in the electrical patterns that occur with exercise, and analyze any abnormalities.
- An angiogram: If you have chest pain or an abnormal heart rhythm, your cardiologist may suggest that you have other tests such as a coronary angiogram or an electrophysiological study (EPS). Both these tests are performed in an x-ray laboratory. The tests allow doctors to see parts of the body, and any medical items such as cardiac catheter tubes or pacing wires, using an x-ray camera. You will be asked to lie down on a special table and will be given a local anaesthetic in your groin. The cardiologist will then place fine tubes, called cardiac catheters or electrodes, into blood vessels in your groin. These are gently passed through the heart. During a coronary angiogram, the coronary arteries (the arteries that supply blood to the heart muscle) are injected with a dye to reveal any narrowing that could be caused by coronary heart disease.An EPS (electrophysiological study) involves placing electrical leads inside the heart to analyze its electrical properties and to bring on arrhythmias. This test can be useful for diagnosing and treating abnormal heart rhythms.
- Angiotensin II receptor antagonist.
- Calcium channel blockers.
- Anti-arrhythmic medicines.
- ICD (internal cardiac defibrillator): An ICD acts in the same way as a pacemaker, but it can also identify any dangerous arrhythmias and deliver an electrical shock to `reset' the heart. Some people have described the shock as feeling like having a `kick in the chest'. An ICD is slightly larger than a pacemaker and is usually positioned under the chest wall muscle below the left shoulder. The procedure may take between one to three hours. Most people have a local anaesthetic as well as sedation, but some may have a full (general) anaesthetic. You will need to have check-ups at the ICD clinic once every three to six months. The battery lasts between four and eight years. When a new battery is needed, the box containing it can be replaced easily.
- Biventricular pacemaker: If your symptoms are severe, you may need to have a biventricular pacemaker. This is a special type of pacemaker that helps to organize the electrical impulses and coordinate the contracting of the heart muscle. This is sometimes known as cardiac resynchronisation therapy (CRT).
- Left ventricular assist device: If your heart failure is very severe, an artificial mechanical device can be fitted to help the heart muscle pump blood out of the heart. The device allows people to live as normal a life as possible out of hospital. These devices are commonly used if someone is waiting for a heart transplant.
- Heart transplantation: For a very small number of people, heart transplantation may be considered.
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