Congestive cardiomyopathy: prevention and treatment

Congestive cardiomyopathy (also called dilated cardiomyopathy, DCM) is a serious disease in which the heart does not pump blood as effectively as it should. Due to excessive stretching of the heart muscle over time, it becomes less able to contract. As a result, the heart cannot meet the needs of the organism, and the blood accumulates more and more in the heart chamber, which leads to its overload.

The problem with pumping blood means that an insufficient amount of oxygen and nutrients can get to the organs and tissues of the body.

The body tries to compensate for the disorder in different ways. The heart beats faster to shorten the time after it shrinks, but in the long run less blood circulates, and additional efforts can cause heart palpitations. Also, the cavity of the heart expands to make room for blood that stagnates. The lungs fill with fluid, which causes shortness of breath. The kidneys, when they do not receive enough blood, begin to retain water and sodium, and this ultimately leads to renal failure. With or without treatment, congestive cardiomyopathy most often progresses, that is, the patient's condition gradually worsens.

Video: Dilated cardiomyopathy: Pathophysiology and diagnosis | NCLEX-RN | Khan Academy

Summary of Congestive Cardiomyopathy

Congestive cardiomyopathy (dilated cardiomyopathy, DCM) is the most common type of non-ischemic cardiomyopathy.With dilated cardiomyopathy, the heart's ability to pump blood decreases as the main pumping chamber of the heart, the left ventricle, is enlarged, expanded, and weakened.

Thanks to the compensatory mechanisms, at first the heart chambers react by stretching in order to retain more blood for pumping throughout the body. It helps to strengthen the contraction of the heart and for a short time to maintain the blood supply at the right level.

Over time, the phase of decompensation begins, when the walls of the heart muscle weaken and stop pumping blood strongly enough. The kidneys often respond with fluid (water) and sodium retention. If fluid builds up in the legs, ankles, feet, lungs, or other organs, the body becomes congested. This often leads to heart failure - a term used to describe this condition.

Heart with congestive cardiomyopathy (left) and normal (right)

Symptoms of Congestive Cardiomyopathy

Many people with congestive cardiomyopathy have no symptoms or detect only minor signs. Other patients develop manifestations that can progress as heart function deteriorates.

Symptoms of DCM may occur at any age and may include:

• Confused breathing.
• Swelling of the legs and feet.
• Fatigue (feeling too tired).
• Inability to exercise or perform normal activities.
• Weight gain.
• Cough and stagnation associated with fluid retention.
• Palpitations or flutter in the chest due to irregular heartbeat (arrhythmia).
• Dizziness or feeling of loss of balance.
• Fainting (caused by irregular heart rhythms, abnormal blood vessel reactions during exercise, for no apparent reason).
• Blood clots formed on the background of slowly flowing blood through the vessels.

If a blood clot ruptures, part of it may enter the lungs (pulmonary embolism), kidneys (renal embolism), brain (cerebral embolism or stroke), limbs (peripheral embolism). In such cases, the patient's condition changes dramatically to critical.

Causes of Congestive Cardiomyopathy

In most cases, congestive cardiomyopathy is an idiopathic disease, that is, the exact cause remains unknown . Other possible factors of influence:

• Viral damage of the heart.
• Hereditary predisposition (familial cardiomyopathy).
• Heart valve disease (valvular cardiomyopathy).
• Alcoholism (alcoholic cardiomyopathy).
• Drug Abuse.
• Acceptance of substances that are toxic to the heart.
• Thyroid disease.
• Diabetes.
• Postpartum heart disease (peripapital cardiomyopathy).

About 1/3 of patients with idiopathic DCM have a familial predisposition, so this disease is called familial dilated cardiomyopathy. This variant of DCM is a genetic disorder. In rare patterns of autosomal dominant inheritance (at least two family members have idiopathic DCM), first-degree relatives (parents, brothers and sisters, children) have a 50% chance of inheriting the disease. In such cases, the benefits of risk screening or medical follow-up can be gained.

Video: Dilated cardiomyopathy : Causes, Diagnosis, Symptoms, Treatment, Prognosis

Natural ways to prevent congestive cardiomyopathy

According to some clinicians, the best way to avoid congestive cardiomyopathy, as well as heart failure, is to avoid factors that contribute to the development of the disease. Another option is to carefully manage these conditions if they have already occurred.

1. You need to quit smoking - it's better not to start! This is a major factor in damage to the arteries, so it can cause many heart diseases. It is also important to stay away from passive smoking.
2. Eat healthy for the heart . Foods that help the body primarily contain little saturated fat, trans fat, sugar, or sodium (salt). You should eat more fruits and vegetables, low-fat dairy products, lean protein, such as skinless chicken, and “good” fats found in olive oil, fish, and avocado. Get practical ideas to eat healthy for the heart, you can in Eat Smart.
3. Need to lose weight . Along with a diet, physical activity helps to achieve a healthy weight, which is especially useful for the entire cardiovascular system.

If there is another type of cardiovascular disease or related conditions, it is important to closely monitor your treatment program. Continuing care and taking prescribed medications, such as statins for the normalization of high cholesterol, can be important.

“Recent studies show that the main part of the long-term benefits of statin therapy is to prevent heart failure and cardiomyopathy by preventing heart attacks and coronary events that lead to them,” says cardiologist and medical doctor Johns Hopkins.

Here are some things you can do in addition to lifestyle changes that improve the condition of the damaged heart:

• It is important to monitor your symptoms . Over time, the condition may deteriorate, so you need to familiarize yourself with the changes occurring in the body. Some of them can be solved with the help of various drugs. Daily weighing is one of the easiest ways to monitor fluid retention, as evidenced by a sudden weight gain. Swelling in the legs and feet can also mean that more fluid accumulates in the body.
• It is necessary to follow the important indicators for life . Especially carefully you need to control blood pressure, heart rate, weight, glucose and cholesterol levels in the blood, as well as what the doctor advises.
• Vaccination against influenza and pneumonia can help avoid an infectious lesion, which will be especially difficult for already compromised lungs.
• We must try to keep a positive attitude . Congestive cardiomyopathy is a serious disease, but with the right approach you can get a long and productive life. Since anxiety and depression, which can cause stress in a patient, are common side effects, you should try to find a way out of a stressful state. This can be helped by a support group or psychotherapist, relaxing activities, or a favorite hobby.
• Do not hesitate to ask questions. Depending on the stage of the disease, the doctor will have different recommendations on what should be the activity, including work, exercise and sexual relations.

Drug prevention of congestive cardiomyopathy

In the presence of an expanded left ventricle, the patient has already increased the risks of reducing life expectancy, which can only be slightly prolonged with the help of ACE inhibitors.

In the medical prevention of DCM and similar heart diseases, the identification of patients with a high likelihood of ventricular dysfunction is important. This allows the public health strategy to be involved in the early stages of the disease.

The prevention strategy has already demonstrated its effectiveness in people with acute myocardial infarction. In some patients, especially those who develop heart attacks of the anterior wall, late ventricular dilatation is observed, which significantly increases the incidence and reduces survival.

Early therapy with ACE inhibitors is recommended for the majority of patients with DCM, because it slows down the progression of left ventricular expansion and reduces the incidence and risk of death. Similar assumptions are based on large-scale clinical trials that document the effectiveness of such an intervention.

• The mechanism of action of an ACE inhibitor

A number of potential mechanisms that explain the effectiveness of ACE inhibitors in the prevention of congestive heart failure and cardiomyopathy are considered. The simplest explanation is that ACE inhibitors reduce vascular tone and, by reducing impedance, improve left ventricular emptying. Improving the systolic function of the left ventricle can slow the progression of the disease.

Another possible mechanism is associated with progressive structural changes that occur in the myocardium of the left ventricle. This process of remodeling of the heart muscle is characterized by expansion of the chamber and an increase in muscle mass. Expansion of the cavity occurs due to progressive contractions of the movement of the wall, which ultimately leads to a hypokinetic ventricle. It has been shown that ACE inhibitors slow down the process of change associated with a progressive decrease in the ejection fraction and obvious symptoms of the disease.

Other interventions are the early use of nitroglycerin and beta blockers. These drugs have also been tested in patients with acute myocardial infarction, and various results have been obtained. In particular, some studies have shown that the early use of nitrates was beneficial, while others were not. According to these data, it is likely that selective administration of these drugs may be effective in some patients.

Exercises for the prevention and treatment of congestive cardiomyopathy

If a person with congestive cardiomyopathy has symptoms of heart failure from mild to moderate, then exercise will help improve his well-being.

The best type of exercise

Aerobic exercise brings the greatest benefit to the heart. If done correctly, aerobic exercises can help reduce heart rate and blood pressure, as well as improve breathing (since the heart does not have to work as hard during normal daily life).

Aerobic exercise is:

• Walking.
• Jogging.
• Different types of jumps.
• Riding a bicycle (stationary or outdoors).
• Cross-country skiing.
• Skating.
• Rowing.
• Water aerobics with low impact.

Recommended frequency and intensity

In general, to achieve maximum benefit, you should gradually begin aerobic exercise for a period of 20 to 30 minutes at least three to four times a week.

Exercising every other day helps to maintain regular aerobic exercise schedule. Each session should include warm-up, voltage and cooling. The intensity of the exercise can be assessed from 0 to 10 and refers to how easy or difficult the exercise is.

• 0 - not at all difficult, there are no changes in the frequency of respiration.
• 10 - there is a very serious condition.

In case of congestive cardiomyopathy, the recommended exercise level is 3 to 4 (moderate to somewhat heavy). This scale is individual, so it is important not to compare yourself with others.

During the evaluation, what a person feels when doing the exercises is measured.

The importance of heart rate (HR)

If the heart is very fast, it can consume excessive amounts of energy, and since the body cannot compensate for this increase, signs of heart failure appear. To prevent this, it is possible to calculate the maximum predicted heart rate(MPHSS) using the following formula: 220 is the age of the subject.

The recommended indicator of MHRF is from 60 to 80%. For a safe start, the target zone should be no more than 50% MPHSS and, of course, never exceed 85% MPHSS.

The main benefits of exercise in congestive cardiomyopathy:

• Strengthens the heart and cardiovascular system.
• Reduces risk factors for heart disease, such as high blood pressure and overweight.
• It improves blood circulation and helps the body make better use of oxygen.
• Reduces the symptoms of heart failure, increases the level of energy, so you can perform more exercises without getting tired and not choking.
• Improved muscle tone and physical endurance.
• Fat deposits are reduced and it is possible to quickly achieve a healthy weight.
• Reduced stress, tension, anxiety and depression.

Precautionary measures

The onset of chest pain, heartbeat, dizziness, or severe breathing during a workout should be discussed with your doctor. You need to be careful, use good equipment, monitor self-control. Remember that exercise should be positive.

Surgical treatment of congestive cardiomyopathy

Surgery may be recommended for the treatment of valve disease, especially when scar tissue forms after a heart attack.Also indications are congenital malformations. In addition, some patients may benefit from the introduction of an auxiliary device of the left ventricle. This procedure requires adherence to strict criteria and the presence of end-stage heart failure.

In extreme cases, a heart transplant is performed or other surgical treatment options are performed. In particular, the device is often implanted.

Implantable devices

• Cardiac resynchronization therapy (PCT, such as biventricular stimulation): In some patients with progressive heart failure with DCM, biventricular stimulation (a pacemaker that detects and triggers a heartbeat in the right and left ventricle) improves survival, reduces symptoms, and improves performance. . For people with heart block or some bradycardia (slow heart rate), this pacemaker is also needed to maintain an adequate heart rate.
• Implantable Cardioverter Defibrillators (ICD). These devices are recommended for people at risk of developing life-threatening ventricular arrhythmias or sudden cardiac death. They constantly monitor the heart rhythm. When a very fast heartbeat or an abnormal heart rhythm is detected, the ICD supplies energy (current) to the heart muscle, which causes the heart to contract again normally.

Both devices can be combined into one unit, usually referred to as CRT-D.

Conclusion

Congestive cardiomyopathy is a serious disease, which in some cases can be prevented or at least slowed down its progression. Today there are various ways.

First of all, it is recommended to change your lifestyle, give up bad habits, start eating right. Also, when not very serious condition, regular exercise is recommended. If this does not help, then they resort to medication, and in extreme cases, to surgical treatment and even implantation of devices or heart transplants.

Video: Medical Treatment of Dilated Cardiomyopathy - Chet Patel, MD