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Treatments and drugs
By Mayo Clinic staffThe goals of treatment for dilated cardiomyopathy are to treat an underlying cause if it's known, improve blood flow, reduce symptoms and prevent further heart damage.
Medications
Doctors usually treat dilated cardiomyopathy with a combination of medications. Depending on your symptoms, you might need two or more of these drugs. Several types of drugs have proved useful in the treatment of heart failure and dilated cardiomyopathy. These medications include:
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Angiotensin-converting enzyme (ACE) inhibitors. ACE inhibitors are a type of vasodilator, a drug that widens or dilates blood vessels to lower blood pressure, improve blood flow and decrease the workload on the heart. Examples include enalapril (Vasotec), lisinopril (Prinivil, Zestril) and captopril (Capoten).
ACE inhibitors cause an irritating cough in some people. It may be best to put up with the cough, if you can. Discuss this side effect with your doctor. Switching to another ACE inhibitor or an angiotensin II receptor blocker may relieve the cough.
- Angiotensin II receptor blockers. These drugs, which include losartan (Cozaar) and valsartan (Diovan), have many of the beneficial effects of ACE inhibitors, but they don't cause a persistent cough. They may be an alternative for people who can't tolerate ACE inhibitors.
- Beta blockers. A beta blocker slows your heart rate, reduces blood pressure and prevents some the harmful effects of stress hormones, substances produced by your body that can make heart failure worse and can trigger abnormal heart rhythms. Beta blockers may reduce signs and symptoms of heart failure and improve heart function. Examples of beta blockers include carvedilol (Coreg), metoprolol (Toprol XL) and bisoprolol (Zebeta).
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Diuretics. Often called water pills, diuretics make you urinate more frequently and keep fluid from collecting in your body. The drugs also decrease fluid in your lungs, so you can breathe more easily. Commonly prescribed diuretics for heart failure include bumetanide (Bumex) and furosemide (Lasix).
Because some diuretics make your body lose potassium and magnesium, your doctor may also prescribe supplements of these minerals. If you're taking a diuretic, your doctor will likely monitor levels of potassium and magnesium in your blood through regular blood tests.
- Aldosterone antagonists. These drugs include spironolactone (Aldactone) and eplerenone (Inspra). These medications are diuretics, but they don't reduce potassium levels as much as some other diuretics do. They also may help the heart work better, may reverse scarring of the heart and may help people with severe heart failure live longer. Unlike some other diuretics, spironolactone can raise the level of potassium in your blood to dangerous levels.
- Digoxin (Lanoxin). This drug, also referred to as digitalis, increases the strength of your heart muscle contractions. It also tends to slow the heartbeat. Digoxin reduces heart failure symptoms and improves your ability to live with dilated cardiomyopathy.
- Blood thinning medications. Your doctor may prescribe drugs that thin your blood (anticoagulants). These medications help prevent blood clots. Examples include aspirin and warfarin (Coumadin).
Devices
Implantable devices used to treat dilated cardiomyopathy include:
- Biventricular pacemakers, which use electrical shocks to coordinate the actions of the left and right ventricle.
- 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.
- Heart pumps (left ventricular assist devices, or LVADs). These mechanical devices are implanted into the abdomen or chest and attached to a weakened heart to help it pump.
Heart transplant
You may be a candidate for a heart transplant if medications and other treatments are no longer effective.
- Jeffries JL, et al. Dilated cardiomyopathy. The Lancet. 2010;375:752.
- Dilated cardiomyopathy. American Heart Association. http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_312224.pdf. Accessed July 3, 2011.
- Cardiomyopathy. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/cm/cm_all.html. Accessed July 3, 2011.
- Mestroni L, et al. Dilated cardiomyopathies. In: Fuster V, et al. Hurst's The Heart. 13th ed. New York, N.Y.: The McGraw-Hill Companies; 2011. http://www.accessmedicine.com/content.aspx?aID=7811432. Accessed July 3, 2011.
- Bashore TM, et al. Heart disease. In McPhee SJ, et al. Current Medical Diagnosis & Treatment 2011. 50th ed. New York, N.Y.: The McGraw-Hill Companies; 2011. http://www.accessmedicine.com/content.aspx?aID=3671. Accessed July 3, 2011.
- Hunt SA, et al. 2009 Focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology. 2009;53:e1.
- Grogan M (expert opinion). Mayo Clinic, Rochester, Minn. July 31, 2011.
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