How to recover from decreased physical fitness due to dilated cardiomyopathy?

Written by Xie Zhi Hong
Cardiology
Updated on November 05, 2024
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Dilated cardiomyopathy is diagnosed after excluding conditions such as hyperthyroidism, hypertension, coronary heart disease, cardiac hypertrophy, or myocarditis as underlying causes. Generally, the exact cause of dilated cardiomyopathy is unknown, rendering causal treatment impossible. Once diagnosed with dilated cardiomyopathy, it is impossible to completely cure the condition. The only approach is to manage symptoms and prevent further progression of the disease. Typically, this involves the use of beta-blockers, ACE inhibitors, and diuretics. If the patient has severe cardiac dysfunction, drugs like digoxin, which strengthen heart function, may be considered. If medication does not adequately control the condition, other treatments like CRT might be considered, as well as the use of phosphodiesterase inhibitors, diuretics, or intravenous cardiotonic glycosides.

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Treatment of Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy, due to unknown causes and often related to genetic factors, is difficult to prevent. It is important to guide patients on how to lead their lives, reminding them to avoid intense physical activities, heavy lifting, or breath-holding to reduce the incidence of sudden death. Avoid using drugs that enhance myocardial contractility and reduce cardiac capacity load, such as digoxin and nitrates, to decrease the aggravation of left ventricular outflow tract obstruction. The treatment principle for this disease is to slow down the hypertrophy of the myocardium, prevent tachycardia, and maintain normal sinus rhythm. It also aims to relieve the narrowing of the left ventricular outflow tract and counteract arrhythmias. Currently, the use of beta blockers and calcium channel blockers is advocated. For severe obstructive patients, interventional and surgical treatments can be carried out, including the implantation of a dual-chamber DTD pacemaker, and the ablation or removal of hypertrophied interventricular septum myocardium.

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Can people with cardiomyopathy run?

Whether a person with myocardial disease can run or not depends on the extent of myocardial damage and clinical symptoms. If the myocardial damage is severe and there are significant clinical symptoms of heart failure and arrhythmia, this group should not run and needs bed rest. If strenuous activity would worsen heart failure, the myocardial damage is mild, with no typical clinical symptoms, and does not affect daily activities, this group can engage in appropriate exercises like walking or running, but the duration should not be too long, about 20 to 30 minutes each time.

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Is dilated cardiomyopathy more serious or is myocardial ischemia more serious?

This has to be judged comprehensively based on the following conditions: First, the age factor. If it occurs in young people, dilated cardiomyopathy tends to be more severe. This is because dilated cardiomyopathy is an organic heart disease, and myocardial ischemia in young people may not necessarily involve organic heart disease changes, but could also be normal physiological changes in the electrocardiogram. Second, whether there is concurrent cardiac function impairment. Dilated cardiomyopathy definitely involves impairment of the heart's pumping function, whereas myocardial ischemia does not necessarily involve such impairment. Therefore, in most cases, dilated cardiomyopathy is more serious.

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Is cardiomyopathy life-threatening?

Whether cardiomyopathy poses a threat to life depends on the severity of the condition. Mild myocardial damage, if detected early, diagnosed early, and treated with effective medications in a timely manner, generally has a good prognosis, poses no threat to life, and leaves no sequelae. Severe myocardial damage, due to lack of timely treatment, can lead to serious complications such as heart failure, arrhythmias, and cardiogenic shock, which can endanger life safety. Therefore, early diagnosis, early treatment, and prevention of complications are crucial treatment measures for cardiomyopathy.

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Does cardiomyopathy require surgery?

Firstly, whether myocardial disease requires surgery, we need to clarify the type of myocardial disease and the stage of myocardial disease, that is, the stage of heart function that has been affected. There are many types of myocardial diseases, including dilated cardiomyopathy, ischemic cardiomyopathy, and restrictive cardiomyopathy, for instance. The treatment plans for different types of myocardial diseases are not exactly the same. For example, dilated cardiomyopathy is generally treated with medication, and only in the very late stages of dilated cardiomyopathy, or what is known as stage IV heart function, when conventional medication is ineffective, heart transplantation might be considered if a donor is available and conditions allow. However, currently, heart donors are extremely rare, making this option quite difficult to achieve. The latest advances in clinical research have introduced artificial mechanical hearts available for transplantation, but the costs of surgery are very high, and the technology is not very mature yet. Therefore, the chances and opportunities for surgery are not very great and must be decided based on the situation. For other conditions, such as ischemic cardiomyopathy, if it is clearly caused by severe ischemia, we might consider addressing the factors causing myocardial ischemia, such as performing a coronary angiography. If there is severe coronary artery stenosis, we might consider implementing a coronary artery stent or coronary artery bypass grafting to alleviate the ischemic factors. In cases like restrictive cardiomyopathy, if there are severe restrictive factors contributing to the disease, surgical treatment might also be pursued.