Treatment of patients with dilated cardiomyopathy may best be divided into immediate and long-term time frames.
If the patient is critically ill, initial treatment can require lifesaving measures such as placement of a breathing tube and use of a mechanical ventilator. Acutely ill patients may need intravenous (IV) fluids and medicines to improve blood pressure and heart function. The sickest patients may need to have help from an artificial heart-lung machine called ECMO.
Diuretics are medicines designed to remove extra fluid from the body. Blood thinners are used when clots form within the poorly functioning heart chambers. The dilated heart may cause rhythm problems and medicines can help with these issues.
Once the patient is more stable, long-term care can involve a number of strategies. Medicines such as captopril and enalapril relax the arteries in the body, lower the blood pressure and make it easier for the heart to pump blood to the rest of the body. Common diuretics, like Lasix and Aldactone, are used to reduce the extra fluid in the lungs. Digoxin is an oral medicine that improves the pumping function of the heart, as well as helps prevent certain types of arrhythmias.
Research in adults has shown that the use of a group of blood pressure medicines called beta-blockers (propranolol, atenolol, carvedilol) has some long-term benefit, and these are sometimes used in children.
Patients with hypertrophic cardiomyopathy may have trouble with abnormal, fast heart rates. They may need medicines to slow their heart rate (beta-blockers) or even electrical shock to stop these abnormal rhythms. These patients may also need some of the same life-saving treatments mentioned above.
In patients who have had a life-threatening arrhythmia, which can be caused by the thickened ventricle, or have risk factors for such arrhythmias, surgically placed devices can “shock” a patient instantly at the time of a life-threatening event. Such devices are called ICDs (internal cardioverter / defibrillator).
The more chronic treatment options for hypertrophic cardiomyopathy address both the problems of arrhythmia and obstruction to flow by the thickened heart muscle. Treatment for outflow obstruction can include medicines such as beta-blockers (atenolol, metoprolol) and calcium channel blockers (verapamil), designed to slow the heart rate and “relax” the heart, thereby decreasing the obstruction. Diuretics and digoxin are not usually used in this type of cardiomyopathy as it can worsen the obstruction of blood flow out of the heart. There is some controversy as to whether surgically removing some of the thickened muscle is of any benefit. Sometimes surgery on the mitral valve, if it is involved in the obstruction, is performed, although this too is controversial.
Immediate and Long-Term Care
Patients with restrictive cardiomyopathy are at high risk for blood clots within the heart, particularly the enlarged upper chambers. Blood thinners such as aspirin, Coumadin (warfarin) or Lovenox may be needed. Gentle use of diuretics can also help some patients. ICDs are also used because these patients are at risk for sudden cardiac arrest related to fast or slow rhythms.
Immediate and Long-Term Care
Patients with ARVD can benefit from treatment with medicines to limit abnormal rhythms. Treatment also consists of placement of an ICD to protect against sudden cardiac events such as an arrest. In certain cases, a catheter-based procedure to eliminate the abnormal rhythm can be performed.