Dilated Cardiomyopathy.

The management of patients with dilated cardiomyopathy (DCM) heart failure starts with the determination of the underlying diagnosis, definition of the hemodynamic character (eg, systolic, diastolic, valvular, right- and left-sided heart dysfunction), recognition of complicating factors (eg, atrial fibrillation, renal dysfunction), and consideration for any surgically remedial lesions (eg, severe valvular regurgitation, high-grade coronary artery occlusive disease). Angiotensin-converting enzyme inhibitors, beta-blocking agents, digoxin, and judicious diuretic administration make up the therapeutic plan for patients with symptomatic DCM heart failure. Angiotensin-converting enzymes are indicated for patients with DCM who have mild or no detectable symptoms; whether this subgroup would benefit from long-term beta-blockade remains to be established. Spirolactone also has been shown to be effective in patients with more advanced stages of heart failure. Biventricular pacing (cardiac resynchronization therapy) recently has been approved for use in patients with DCM and a left ventricular or intraventricular conduction defect and a QRS duration of longer than 140 msec. More intense pharmacotherapy, mechanical devices, and transplantation are directed at patients with severely symptomatic end-stage DCM. The effectiveness of any heart failure treatment plan is very much dependent on nonpharmacologic approaches, including dietary measures, exercise conditioning, and similar considerations, all of which are best delivered by dedicated heart failure programs.