cardiovascular disorders
Dilated Cardiomyopathy
Treatment of Dilated Cardiomyopathy
Cause (if any) treated Standard therapy for Heart failure with reduced ejection fraction (HFrEF) None Anticoagulants when atrial fibrillation or other indication is present Sometimes implantable cardioverter-defibrillator, cardiac resynchronization therapy (CRT), left ventricular assist device, or transplantation Immunosupression in patients with giant cell myocarditis, eosinophilic myocarditis, Sarcoidosis , or other autoimmune diseases (eg, systemic lupus erythematosus) Treatable causes (eg, Toxoplasmosis , acute Otherwise, treatment is the same as for Treatment : angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, Special precautions are needed in the treatment of Heart Disease in Pregnancy . Many medications (eg, ACE inhibitors and Prophylactic Anticoagulants has been used in the past to prevent mural thrombus in other forms of cardiomyopathy. The use of anticoagulants for patients with reduced left ventricular function and in sinus rhythm remains controversial, and anticoagulant use in this situation is not routine. Both the American Heart Association and European Society of Cardiology Guidelines recommend considering anticoagulation therapy in patients with peripartum cardiomyopathy who have very low ejection fractions given the risk of a hypercoagulable state during pregnancy ( Treatment references , Medical treatment of heart failure reduces risk of arrhythmia, but an Device therapy may be used to prevent death due to sudden arrhythmia in patients who continue to have a reduced ejection fraction despite optimal medical therapy. Because atrioventricular (AV) block during acute myocarditis often resolves, a permanent pacemaker is usually not needed acutely. However, a permanent pacemaker may be required if AV block persists or develops during the chronic dilated phase. If patients have a widened QRS interval with a low left ventricular ejection fraction and severe symptoms despite optimal medical treatment, Patients with refractory heart failure despite treatment may become candidates for Heart Transplantation . Selection criteria include absence of associated systemic disorders and psychologic disorders and high, irreversible pulmonary vascular resistance; because donor hearts are scarce, younger patients (usually 1.Bozkurt B, Colvin M, Cook J, et al: Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association [published correction appears inCirculation134(23):e652, 2016].Circulation134(23):e579–e646, 2016. doi:10.1161/CIR.0000000000000455 2.Bozkurt B, Colvin M, Cook J, et al: Current diagnostic and treatment strategies for specific dilated cardiomyopathies: A Scientific Statement From the American Heart Association.Circulation134(23):e579–e646.2, 2016. doi:10.1161/CIR.0000000000000455 3.Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al: 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy: The Task Force for the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC).Eur Heart J39: 3165–3241, 2018. doi: 10.1093/eurheartj/ehy340 