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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. These drugs help people with dilated cardiomyopathy live longer and feel better. 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 (A-II) receptor blockers (ARBs). 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). They're primarily potassium-sparing diuretics, but they have additional properties that 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.
- Anticoagulants. Your doctor may prescribe anticoagulants, which prevent blood clots. These include aspirin and warfarin (Coumadin).
Devices
Implantable devices that may correct irregular heartbeats include:
- Biventricular pacemakers, which use electrical shocks to coordinate contractions between 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 cardiac arrest. They can also function as pacemakers.
Heart transplant
You may be a candidate for a heart transplant if medications and other treatments are no longer effective.
- Cardiomyopathy. National Heart Lung and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/cm/cm_all.html. Accessed July 14, 2009.
- Cooper LT. Definition and classification of the cardiomyopathies. http://www.uptodate.com/home/index.html. Accessed July 14, 2009.
- Maron BJ, et al. Contemporary definitions and classification of the cardiomyopathies: An American Heart Association scientific statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation 2006;113:1807.
- Weigner M, et al. Causes of dilated cardiomyopathy. http://www.uptodate.com/home/index.html. Accessed July 14, 2009.
- Hershberger RE. Genetics of dilated cardiomyopathy. http://www.uptodate.com/home/index.html. Accessed July 14, 2009.
- Podrid PJ, et al. Secondary and primary prevention of sudden cardiac death in heart failure and cardiomyopathies. http://www.uptodate.com/home/index.html. Accessed July 14, 2009.
- Heart failure. National Heart Lung and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/Hf/HF_All.html. Accessed July 14, 2009.
- Hare JM. The dilated, restrictive and infiltrative cardiomyopathies. In Libby P. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/book/player/book.do?method=display&type=bookPage&decorator=header&eid=4-u1.0-B978-1-4160-4106-1..50067-4&uniq=151686941&isbn=978-1-4160-4106-1&sid=867495152#lpState=open&lpTab=contentsTab&content=4-u1.0-B978-1-4160-4106-1..X5001-8--TOP%3Bfrom%3Dcontent%3Bisbn%3D978-1-4160-4106-1%3Btype%3DbookHome. Accessed July 14, 2009.
