Heart Disease UK

From Richard N. Fogoros, M.D.,

Treating dilated cardiomyopathy and heart failure
The first rule of treating cardiomyopathy and heart disease is to aggressively seek out and treat any reversible underlying cause. Treatment for coronary artery disease or valvular disease needs to be optimized. Thyroid disease, anemia, or nutritional deficiencies need to be reversed. Abnormal tachycardias need to be aggressively controlled.
While attempting to identify and stabilize the underlying cause, treatment should be instituted to minimize the symptoms of heart failure and to optimize the efficiency of the failing heart. The mainstay of treatment has been and remains medication, but transplant surgery has saved thousands of lives, and new medical devices are being developed to treat cardiomyopathy and heart disease.

Drugs
Digitalis. Digitalis agents improve the force of heart muscle contraction by increasing the amount of calcium inside cardiac cells.
If digoxin helps this condition, its effect seems to be marginal. Also, a recent study suggests that digoxin might actually be detrimental in women who have heart failure.
Diuretics. Diuretics, or “water pills,” increase the elimination of sodium through the kidneys. Eliminating sodium reduces the fluid retention that occurs in heart failure, helps rid the lungs of the excess fluids that cause shortness of breath, and helps reduce leg swelling. Most patients who have experienced an episode of heart failure are placed on daily therapy with diuretics.
ACE inhibitors. ACE inhibitors act to dilate blood vessels in the body. This is extremely important, because in heart failure the body responds by constricting blood vessels, and the constriction of blood vessels greatly increases the work of the heart. ACE inhibitors have proven to be the most effective in improving both the symptoms and the outcome of patients with heart failure. Virtually every patient with heart failure should be on an ACE inhibitor.

Antiarrhythmic therapy.
Unfortunately, patients with moderate to severe dilated cardiomyopathy have a significantly increased risk of sudden death from ventricular arrhythmias. Also unfortunately, antiarrhythmic drugs have never been shown to reduce that risk. The implantable defibrillator has been shown to significantly reduce mortality in certain subsets of patients with cardiomyopathy, particularly in those with prior heart attacks. A trial has shown that patients with prior heart attacks whose ejection fractions are less than 30% have a significantly improved survival when they receive implantable defibrillators.

Cardiac resynchronization therapy (CRT).
CRT is a new form of treatment for some patients with dilated cardiomyopathy. CRT is a form of cardiac pacing that stimulates both ventricles (right and left) simultaneously. The purpose of CRT is to coordinate the contraction of the ventricles, which improves the efficiency of the heart, and increases the amount of blood pumped with each heart beat. Any patient with dilated cardiomyopathy and a complete or partial bundle branch block should be considered for CRT.