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INTRODUCTION CARDIOMYOPATHY-2

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A firm diagnosis typically requires a chest x ray to show whether the heart is enlarged, an electrocardiogram to reveal any abnormal electrical activity of the heart, and an echocardiogram, which uses sound waves to produce pictures of the heart.
Other, more specific tests may also be needed. These include:

A radionuclide ventriculogram. This involves injecting low-dose radioactive material (usually equal to that in a set of chest x rays) into a vein, through which it flows to the heart. Pictures are generated by a special camera to show how well the heart is functioning.

A cardiac catheterization. In this procedure, a thin plastic tube is inserted through a blood vessel until it reaches the heart. A dye is injected and x rays taken to assess the heart's structure and function.
Treatment
Since dilated cardiomyopathy is hard to diagnose early, it is rarely treated in its beginning stage.
The goal of treatment is to relieve any complicating factor, if known, control the symptoms, and stop the disease's progression. However, no cure now exists.
Therapy begins with the elimination of obvious risk factors, such as alcohol consumption. Weight loss and dietary changes, especially salt restriction, may also be advised.
Drugs used to treat the condition include:

Diuretics, which reduce excess fluid in the body;

Vasodilators, such as angiotensin-converting enzyme (ACE) inhibitors, which relax blood vessels, helping to lower blood pressure and reducing the effort needed by the heart to pump blood through the body;

Digitalis, which helps to improve pumping action and regulate heartbeat; and,

Calcium blockers or beta blockers, which may be used in some patients to help regulate heartbeat and to alter the work of the heart muscle.
Also, patients with irregular heartbeats may be put on any of various drugs to control the rhythm.
In critical cases where the condition is advanced and the patient does not sufficiently respond to other treatments, a heart transplantation may be needed. The patient's heart is replaced with a donor heart. Most heart transplant recipients are under age 60 and in good health other than their diseased heart.
Course of the disease
As the heart enlarges, it steadily decreases its efficiency in pumping blood and the amount of blood it can pump. As a result, some patients cannot perform even simple physical activities.
However, the disease also may remain fairly stable for years, especially with treatment and regular evaluation by a physician.
Unfortunately, by the time it is diagnosed, the disease often has reached an advanced stage and heart failure has occurred. Consequently, about 50 percent of patients with dilated cardiomyopathy live 5 years once heart failure is diagnosed; about 25 percent live 10 years after such a diagnosis.
Typically, patients die from a continued decline in heart muscle strength, but some die suddenly of irregular heartbeats.
For patients with advanced disease, heart transplantation greatly improves survival: 75 percent of patients live 5 years after a transplantation. However, in the United States, the scarcity of donor hearts limits the number of transplantations to about 2,000 persons a year. Those who qualify for heart transplantation often have to wait months, or even years, for a suitable donor heart. Some patients with dilated cardiomyopathy die awaiting a transplant but, according to recent studies, others improve enough from aggressive medical treatment to be taken off the waiting list.
Also, some critically ill cardiomyopathy patients with declining heart function use a small, implanted mechanical pump as a bridge to transplantation. Called left ventricular assist devices (LVADs), these pumps take over part or virtually all of the heart's blood pumping activity. The devices provided only temporary assistance and are not now used as substitutes for heart transplantation.
 

Hypertrophic Cardiomyopathy

The second most common form of heart muscle disease is hypertrophic cardiomyopathy. Physicians sometimes call it by other names: idiopathic hypertrophic subaortic stenosis (IHSS), asymmetrical septal hypertrophy (ASH), or hypertrophic obstructive cardiomyopathy (HOCM).
In hypertrophic cardiomyopathy, the growth and arrangement of muscle fibers are abnormal, leading to thickened heart walls. The greatest thickening tends to occur in the left ventricle (the heart's main pumping chamber), especially in the septum, the wall that separates the left and right ventricles. The thickening reduces the size of the pumping chamber and obstructs blood flow. It also prevents the heart from properly relaxing between beats and so filling with blood. Eventually, this limits the pumping action.

 

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