Your doctor will take a personal and family medical history. Then, he or she will also do a physical exam using a stethoscope to listen to your heart and lungs, and order tests. Your doctor may refer you to a heart specialist (cardiologist) for testing.
Tests your doctor might order include:
- Blood tests. These tests give your doctor information about your heart. They also may reveal if you have an infection, a metabolic disorder or toxins in your blood that can cause dilated cardiomyopathy.
- Chest X-ray. Your doctor may order a chest X-ray to check your heart and lungs for changes or abnormalities in the heart's structure and size, and for fluid in or around your lungs.
- Electrocardiogram (ECG). An electrocardiogram — also called an ECG or EKG — records electrical signals as they travel through your heart. Your doctor can look for patterns that may be a sign of an abnormal heart rhythm or problems with the left ventricle. Your doctor may ask you to wear a portable ECG device (Holter monitor) to record your heart rhythm for a day or two.
- Echocardiogram. This primary tool for diagnosing dilated cardiomyopathy uses sound waves to produce images of the heart, allowing your doctor to see whether your left ventricle is enlarged. This test can also reveal how much blood is ejected from the heart with each beat and whether blood is flowing in the right direction.
Exercise stress test. Your doctor may have you perform an exercise test, either walking on a treadmill or riding a stationary bike. Electrodes attached to you during the test help your doctor measure your heart rate and oxygen use.
This type of test can show the severity of problems caused by dilated cardiomyopathy. If you're unable to exercise, you may be given medication to create stress on your heart.
- CT or MRI scan. In some situations, your doctor might order one of these tests to check the size and function of your heart's pumping chambers.
Cardiac catheterization. For this invasive procedure, a long, narrow tube is threaded through a blood vessel in your arm, groin or neck into your heart. The test enables your doctor to see your coronary arteries on X-ray, measure pressure in your heart and collect a sample of muscle tissue to check for damage that indicates dilated cardiomyopathy.
This procedure may involve having a dye injected into your coronary arteries to help your doctor study your coronary arteries (coronary angiography).
- Genetic screening or counseling. If your doctor can't identify the cause of dilated cardiomyopathy, he or she may suggest screening of other family members to see if the disease is inherited in your family.
If you have dilated cardiomyopathy, your doctor might recommend treatment for the underlying cause, if known. Treatment may also be suggested in order to improve blood flow and prevent further damage to your heart.
Doctors usually treat dilated cardiomyopathy with a combination of medications. Depending on your symptoms, you might need two or more of these drugs.
Drugs that have proved useful in the treatment of heart failure and dilated cardiomyopathy include:
Angiotensin-converting enzyme (ACE) inhibitors. ACE inhibitors are a type of drug that widens or dilates blood vessels (vasodilator) to lower blood pressure, improve blood flow and decrease the heart's workload. ACE inhibitors may improve heart function.
Side effects include low blood pressure, low white blood cell count, and kidney or liver problems.
- Angiotensin II receptor blockers. These drugs have many of the beneficial effects of ACE inhibitors and may be an alternative for people who can't tolerate ACE inhibitors. Side effects include diarrhea, muscle cramps and dizziness.
Beta blockers. A beta blocker slows your heart rate, reduces blood pressure and may prevent some of the harmful effects of stress hormones, which are substances produced by your body that can worsen heart failure and trigger abnormal heart rhythms.
Beta blockers may reduce signs and symptoms of heart failure and improve heart function. Side effects include dizziness and low blood pressure.
- Diuretics. Often called water pills, diuretics remove excess fluid and salt from your body. The drugs also decrease fluid in your lungs, so you can breathe more easily.
- Digoxin. This drug, also known as digitalis, strengthens your heart muscle contractions. It also tends to slow the heartbeat. Digoxin may reduce heart failure symptoms and improve your ability to be active.
- Blood-thinning medications. Your doctor may prescribe drugs, including aspirin or warfarin, to help prevent blood clots. Side effects include excessive bruising or bleeding.
Implantable devices used to treat dilated cardiomyopathy include:
- Biventricular pacemakers, which use electrical impulses to coordinate the actions of the left and right ventricles.
- Implantable cardioverter-defibrillators (ICDs), which monitor heart rhythm and deliver electrical shocks when needed to control abnormal, rapid heartbeats, including those that cause the heart to stop. They can also function as pacemakers.
- Left ventricular assist devices (LVADs), which are mechanical devices implanted into the abdomen or chest and attached to a weakened heart to help it pump. They usually are considered after less invasive approaches are unsuccessful.
You may be a candidate for a heart transplant if medications and other treatments are no longer effective.
Lifestyle and home remedies
If you have dilated cardiomyopathy, these self-care strategies may help you manage your symptoms:
- Exercise. Talk to your doctor about what activities would be safe and beneficial for you. In general, competitive sports aren't recommended because they can increase the risk of the heart stopping and causing sudden death.
- Quit smoking. Your doctor can give you advice on what methods can help you stop.
- Don't use illegal drugs or drink alcohol excessively. Using cocaine or other illegal drugs can strain your heart. Before you drink alcohol, ask your doctor for advice.
- Maintain a healthy weight. Extra weight makes your heart work harder. Lose weight if you're overweight or obese.
- Eat a heart-healthy diet. Eating whole grains and a variety of fruits and vegetables, and limiting salt, added sugar, and cholesterol, saturated fats and trans fats is good for your heart. Ask your doctor for a referral to a dietitian if you need help planning your diet.
Preparing for your appointment
If you think you may have dilated cardiomyopathy or are worried about your risk because of a family history, make an appointment with your family doctor. Eventually, you may be referred to a heart specialist (cardiologist).
Here's information to help you get ready for your appointment.
What you can do
- Be aware of any pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet.
- Write down symptoms you're experiencing, including any that may seem unrelated to dilated cardiomyopathy.
- Write down key personal information, including major stresses or recent life changes and a family history of heart disease, stroke, high blood pressure or diabetes.
- List all medications, including vitamins and supplements you're taking.
- Take a family member or friend along, if possible. Someone who accompanies you may remember something that you missed or forgot.
- Be prepared to discuss your diet and exercise habits. If you don't already follow a diet or exercise routine, talk to your doctor about how to get started.
- Write down questions to ask your doctor.
Preparing a list of questions will help you make the most of your time with your doctor. For dilated cardiomyopathy, some basic questions include:
- What is likely causing my symptoms or condition?
- What are other possible causes?
- What tests will I need?
- What's the best treatment?
- What are the alternatives to the primary approach you're suggesting?
- How should I change my diet?
- What's an appropriate level of physical activity?
- How often should I be screened?
- Should I tell my family to be screened for dilated cardiomyopathy?
- I have other health conditions. How can I best manage them together?
- Are there restrictions that I need to follow?
- Should I see a specialist?
- Is there a generic alternative to the medicine you're prescribing?
- Are there brochures or other printed materials I can take with me? What websites do you recommend?
What to expect from your doctor
Your doctor is likely to ask you a number of questions, including:
- When did your symptoms begin?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
- Do any of your blood relatives have dilated cardiomyopathy or other types of heart disease?