III. DILATED CARDIOMYOPATHY
3. On auscultation gallop sounds are typically present.
C. Investigations
1. Chest x-ray shows enlargement of the heart with fluid in the lungs (pleural effusions) and evidence of heart failure.
2. Echocardiogram shows enlargement of all four cham¬bers and the entire muscle wall contracts poorly (global hypokinesis). A pericardial effusion (excess fluid in the pericardial sac) can be seen.
D. Management
Transplantation has a role in selected individuals but does not benefit patients worldwide. Aggressive treatment for heart failure carries the only hope for improved survival and must include the following medications:
1. Diuretics: Furosemide in a dosage to prevent fluid retention, edema, signs of heart failure, and particularly for the relief of shortness of breath.
2. ACE inhibitor therapy: Enalapril or lisinopril or similar ACE inhibitor, see the chapter Heart Failure.
3. Beta blockers: The use of metoprolol or carvedilol is now recognized as essential. These agents have recently been shown to be effective in relieving symptoms as well as improving cardiac function. Lowes et al. reported the study of 53 patients treated with meto-prolol or carvedilol and observed significant improve¬ment that was associated with changes in myocardial gene expression. A study by Cice et al. in 114 dialysis patients with dilated cardiomyopathy treated with carvedilol showed a reduction in left ventricular function, left ventricular volumes, and clinical status.