Dilated cardiomyopathy can it be reversed

Although it is found most often in middle-aged people and more often in men than in women, this condition has been diagnosed in people of all ages, including children. If the chamber walls become weak enough, the heart can no longer perform its normal pumping action.

The heart chambers then expand dilate to make room for this greater blood volume. But, in time, the stretching of the heart muscle causes the heart to get bigger, or enlarge. This is called cardiomegaly. Doctors can usually tell if cardiomegaly is present by measuring the size of your heart. The long-term effects of cardiomegaly are not good.

Your heart will try to increase its rate to pump more blood through your body. And, when the heart cannot contract as well, it will affect your circulation and cause excess body fluid to build up in your lungs, the area above your stomach abdomen , and your legs. This fluid buildup makes breathing difficult and causes swelling called edema.

These are 2 common symptoms of heart failure. Cardiomegaly sometimes leads to abnormal heart rhythms called arrhythmias. Also, blood flows more slowly through an enlarged heart, so blood clots may easily form. These clots can break free and enter the circulation, ending up in the lungs called a pulmonary emboli or blocking a vessel in the brain or heart.

Some doctors think that viral infections may be responsible. Because you may have had the viral infection months or even years before you show any sign of a weakened heart muscle, the exact cause of dilated cardiomyopathy is difficult to pinpoint. Also, heavy drinkers tend to drink alcohol instead of eating food, which leads to poor nutrition.

Other toxic substances, including some chemicals and pesticides, have also been shown to weaken the heart muscle. Also, drug abuse has been found to weaken the heart muscle. Figure 2 The electrocardiogram of the patient with a corrected QT interval after correction of her Serum Calcium level. Her haemoglobin was 8. Creatinine was 5. Her Serum Calcium was Normal range 2. Her echocardiographic findings before supplementing calcium.

On treatment she improved. She was given oral calcium supplementation. She was put on inotropes dopamine and dobutamine diuretics and intravenous calcium gluconate, oral calcium, high dose vitamin D3 and eltroxin. She had a massive lower gastro intestinal bleed 5days after ICCU admission and was given 5 pints of blood transfused over one week. Her blood urea and liver enzymes normalized and she improved.

She was then put on furosemide low doses and carvidilol and aldactone spironolactone inhibitor She improved. She gradually improved and was discharged. She now can walk around and perform house hold tasks. Reversible cardiomyopathies have long fascinated cardiologists around the world. The reversible cardiomyopathies can be classified into two groups, those due to metabolic causes and those due to hypocalcaemia.

The causes of hypocalcaemia are many, and most of the common type of hypocalcaemia has been reported to cause a treatable, reversible cardiomyopathy. Starting from just after birth, a reversible cardiomyopathy was discovered in a new borne with suspected sepsis due to severe Vit D3 deficiency in her mother. On correcting this the baby improved rapidly and survived. Hypocalcaemia due to repeated blood transfusions in a Thalassemia patient has been reported to cause a dilated cardiomyopathy that improved with treatment.

Finally after thyroidectomy, parathyroid deficiency can occur and can cause a reversible cardiomyopathy akin to the one seen in our patient. In these situations plain calcium supplementation helps. Our patient also had some form of myopathy. When she first reported to us she could not raise her arms, her upper limb power was grade 2, but as days went by and she improved, she could sit up, later walk and finally is back to normal mild housework.

The results of supplementation of calcium are so rewarding, this deficiency should be looked for and treated. Cocaine cardiomyopathy should be looked for when a very young patient presents with an acute coronary syndrome and an elevated blood pressure, and heart failure.

Other correctible cardiomyopathies are Takotsubo myocarditis, tachycardiomyopathy, cocaine cardiomyopathy, drug induced cardiomyopathy due to interferon alpha therapy, Sunitinib and Sorafenibtherapy, amphetamine induced cardiomyopathy, thyrotoxic cardiomyopathy or sepsis. The cardiomyopathy associated with interferon alpha is interesting. The myocarditis in the case described was diagnosed by myocardial biopsy. They used the Dallas criteria to diagnose myocarditis. Interferon alpha causes a cell mediated immune injury; in the above case all the tests for antibodies to different myocardial components were negative.

Sepsis also causes an acute cardiomyopathy that reverts to normal if the patient survives. In sepsis it is believed that cytokines mediate a cardiomyopathy. The cytoplasmic reticular Ca-ATPase is affected in sepsis. The phosphorylation of SR proteins is affected in late sepsis. This is impaired mitochondrial oxygen content in spite of adequate oxygen supply. Further during sepsis TNF alpha tumour necrosis factor also causes an inflammatory injury and a reduction in left ventricular function.

The C5 complement activation produces C5a a potent anaphyla toxin and C5b a complement that damages the bacterial membrane. C5a activation produces inflammation and cardiac depression. Exposure to C5a depresses myocardial contractility immediately on testing in isolated cardiomyocytes in culture.

TNF alpha also triggers myocardial apoptosis. Both hypothyroidism and hyperthyroidism cause reversible heart failure. Dhadke 13 describe a florid case of hyperthyroidism with heart failure. This patient dramatically improved with the antithyroid drug-carbimazole 10 mg three times a day and a beta-blocker. The patient was in atrial fibrillation and returned to sinus rhythm within 2weeks of initiation of therapy.

Their patient was a 58years old male, who was in the terminal stages of heart failure when a bilateral adrenalectomy proved life-saving. We now take for granted the recovery after biventricular pacing. But Blanc et al. They studied 29 patients with left bundle branch block LBBB and severe heart failure. This change occurred after left ventricular pacing was performed via the coronary sinus. Strangely though we did not pay much attention to it at the time, our patient also had a reversible myopathy.

There are many causes of reversible myopathy like, due to drugs like statins, or due to hypocalcaemia or hypokalaemia, due to hypothyroidism, or due to hyperthyroidism or due to mitochondrial myopathies that occur in children, or infants.

So in an acute heart failure with muscle weakness, reversible causes of myopathy should be looked for. Generally hereditary degenerative myopathies develop slowly over a long period. Mitochondrial myopathies generally have a bad prognosis. But recently Horvath et al. Here the infants who are affected either die or spontaneously recover.

The baby classically presents with hypotonia, as a floppy baby. Intensive supportive measures are needed to keep the baby alive. Those with the maternally inherited mutation m. The spontaneous recovery is supposed to be due to the increased mtDNA synthesized by the liver as the child grows to one year of age. Compared to newborns, the infants of 1 year synthesize more mtDNA. The other explanation for this improvement is considered to be a switch in the isoforms of mtDNA.

The question of recovery versus remission has potentially been answered in this pilot study. In we have no true signature of recovery, and these patients indeed are in cardiac remission and do have an indefinite indication for continuing their evidence-based medical therapy without interruption. Asked whether there were any signals of patient factors that could help identify someone who could be safely weaned from their meds, Halliday stressed that the study was not powered to look for that kind of information.

That said, risk factors associated with relapse included higher baseline NT-proBNP, greater number of baseline medications, and baseline prescription of an MRA. Greater global strain on CMR was associated with a lesser likelihood of relapse.

The magnitude of the question justified its inclusion. But I think they checked all the boxes for making sure this was done in a very safe and monitored way, so that even if the outcome was what it turned out to be, the harm was minimalized. She did her undergraduate degree at McGill…. Withdrawal of pharmacological treatment for heart failure in patients with recovered dilated cardiomyopathy TRED-HF : an open-label, pilot, randomised trial.

Stopping medication for heart failure with improved ejection fraction. Stay up-to-date with breaking news, conference slides, and topical videos covering the spectrum of CVD. Join our newsletter! Register today! The answer is not the one patients were hoping for. By Shelley Wood. Created with Sketch. November 11, Next Steps Jane E.

Disclosures Halliday and Lloyd-Jones report no relevant conflicts of interest.