The core consists of an outer layer, the pericardium, a call muscular layer and an inner layer myocardium, endocardium. The myocardium is the part that is responsible for exercising the power to carry out the blood pumping and that shapes the heart chambers, the atria and ventricles.
Sometimes and for different causes myocardial wall thickness and consequently decrease the heart chambers are enlarged and the myocardium can not do its job of promoting blood efficiently. When this happens we say that the patient has a dilated cardiomyopathy.
The dilation of the cardiac chambers can answer many causes. Most of the time is idiopathic, unknown. In some cases there is a familial form whose pattern of inheritance is unknown.
Secondary causes of dilated cardiomyopathy frequently include:
Dilated cardiomyopathy is the most common secondary due to alcoholism. Alcohol alters membrane of myocardial cells and causes them to die, thereby weaken the walls and cavities dilate. It must be said, however, that this case, unlike the primaries, is reversible, so that if the patient stops drinking and deterioration is not very advanced, you can recover the normal function of the heart pumping in a three years.
In general there is a destruction of myocardial muscle cells, so that the partitions are decreasing cardiac cavities thickness and increase in size, allowing the inflow of blood. With less thickness, the heart can not pump all the blood in each systole, so that each beat there is blood that is retained and not leave the bloodstream, leading to medium term to heart failure.
In the early stages the patient has no symptoms but as the disease progresses down symptoms of heart failure, with dyspnea, orthopnea, edema and an enlarged liver. A pulmonary auscultation crackles are appreciated.
It is also common for patients that have sinus tachycardia that as the disease progresses can lead to atrial fibrillation.
Because blood is trapped in the ventricles, there is a risk to form thrombi and that they can leave the bloodstream and cause embolisms by any peripheral artery obstruction.
Diagnosis is based on the suspicion in all patients with symptoms of heart failure such as those discussed above. A cardiac auscultation accessories can hear sounds and murmurs in systole phase because of mitral valve failure by left ventricular dilation. If puffs seen in the diastole phase of the heart cycle is suspected source of hypertrophic cardiomyopathy and dilated not, and whether the patient has hypertension.
The electrocardiogram can appreciate and nonspecific changes if any, sinus tachycardia or atrial fibrillation.
In the chest radiograph can be observed cardiomegaly and signs in the lungs of pulmonary hypertension.
The echocardiogram is the test that will diagnose and better assess the severity of dilated cardiomyopathy. It will be appreciated left ventricular dilatation, with enlarged diameters in the two phases of the cardiac cycle, increasing the volume in the filling phase and a blood outlet below 30% of normal, what is known as ejection fraction. The walls are often thinner, but may also have a normal thickness. Furthermore, echocardiography allows observing whether there thrombi within the left ventricle. Another test that can be assessed is dilated radionuclide ventriculography.
If you perform a hemodynamic study that pressures will be late ventricular filling will be higher in case of suffering from dilated cardiomyopathy.
If infiltrating suspect a cause, such as amyloidosis, you can perform a myocardial biopsy, although this test is rarely performed.
The treatment will be of heart failure symptoms and derivatives. Hidrosalino contribution will be reduced in the diet and administered diuretics, vasodilators (ACEI group especially since been shown to increase survival of these patients) and sometimes digoxin.
If dilation is important, there thrombi in the left ventricle or the patient experiences atrial fibrillation anticoagulant be administered to reduce the risk of thromboembolism.
In case of severe arrhythmias be treated pharmacologically or by autoimplantable defibrillator (ICD), a device connected to the heart via electrodes monitors the heart rhythm and if it detects an altered heart rate and try to reverse it at a rate normal by electric shock.
In advanced cases in which the patient does not respond to treatment, it is possible to perform a heart transplant.
The cessation of alcohol is essential to treat dilated cardiomyopathy due to alcoholism, because it is a potentially reversible cause. In case of illness that may be associated with this disease is convenient to conduct regular checks and go to the specialist before any symptoms. A healthy diet low in fat and salt and moderate physical activity may determine a lower risk of developing the disease and a better prognosis in case of suffering.
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