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Heart & Cardiology/Suffering from Dilated Cardiomyopathy

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QUESTION: I'm a 50 year old woman suffering from Ischemic Dilated Cardiomyopathy. I was diagnosed with this disease 9 months ago with Moderate LV dysfunction EF - 35%, LV global hypokinesia, mild MR, Grade III LV diastolic dysfunction, no clots/veg/PE. I'm currently under the following medications - Torsemide 10mg & Spironolactone 50mg, Carvedilol 3.125mg, Ramipril 2.5mg, Lanoxin 0.25mg, Ivabradine 5mg. Currently the doctor says I'm stable and I visit the doctor once in 3 months. I wanted guidance on what changes I should bring in my lifestyle and on my survival chances.

ANSWER: Hi,

Has any other work up been done to rule out ischemic heart disease, such as a stress test or s heart catheterization?

Its good your dr feels you are clinically stable. your medicine regimen is excellent and basically has incorporated all the evidence based medications proven to improve outcome in those with cardiomyopathy. in terms of lifestyle, exercise as tolerated, control of risk factors such as blood pressure and diabetes, and some form of sodium restriction (<2gm per day) and fluid restriction (<1.5-2 liters per day) if there are symptoms remaining.

In terms of survival, in your favor is that you are clinically stable and you have a good medication regimen that you adhere to, all of which can improve outcome. Your heart pumping function will be monitored over time to assess the response to therapy and there is evidence to suggest that in class where the ef remains <35% implantation of a defibrillator can improve survival also. There have been remarkable advances in recent years which mean there are a multitude of long term options available if your condition were to deteriorate, these include transplantation and the use of left ventricular assist devices that have meant there is often hope in situations where there used to be none. As long as you are referred to the correct specialists when appropriate these options will be on the table. The good news for now is that you are stable and appear to be doing well.

Hope that was helpful,

---------- FOLLOW-UP ----------

QUESTION: Angiogram was conducted and no serious clots were identified. Also my father and mother succumbed to Ischemic heart disease. My brother and son developed Dilated cardiomyopathy as they were suffering from Duchenne's muscular dystrophy. My brother passed away but my son is stable and is undergoing treatment too. Is my daughter at risk too? She is currently 27 and a checkup(X-ray, echo) was conducted once and no such problems were detected. How often should she have a heart checkup?

Answer
Hi,

Its good your angiogram was normal as this rules out ischemia as a cause of the cardiomyopathy, so you have a non ischemic type. In terms of Duchenne, your daughter is not generally at risk at the inheritance pattern is x linked and so while sons are at risk of disease in a 50/50 pattern, daughters may be carriers of the disease and while they may not suffer from it, may pass it on to next generations, if affected. The cardiomyopathy risk depends on the genetic profile and type of disease, it is not common. If a female suffers from duchenne, then they may be at risk of the cardiomyopathy although it is generally a milder form than the male version. The frequency of check ups depends on clinical symptoms and also the stability of disease. If everything is normal and the clinical situation does not change, your cardiologist my recommend less frequent echocardiographic check up, however clinical check up should be on a yearly basis and its important not to be lost to follow up.

Hope that was helpful.  

Heart & Cardiology

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Mustafa Ahmed MD

Expertise

Cardiology, Interventional Cardiology, Cardiac Surgery, Hypertension, Pulmonary Embolism, Structural and Valve Disease

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Board Certification Internal Medicine and Cardiology Interventional and Structural Cardiology

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http://blog.myheart.net

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Multiple Publications In High Quality Peer Reviewed Journals. Internationally Recognized.

Education/Credentials
MD from The Royal Victoria University of Manchester, England Medicine, Cardiology, Interventional Cardiology, Research Training - University of Alabama

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