The treatment of
dilated cardiomyopathy is primarily concerned with that of
congestive heart failure. Digitalis is widely use in
dilated cardiomyopathy but an improvement in the prognosis has not yet been demonstrated. Furthermore, the effects of digitalis in patients with sinus rhythm are debatable. If
dilated cardiomyopathy induces
atrial fibrillation and
tachyarrhythmia, digitalis should be used.
Diuretics are helpful in the treatment of
congestive heart failure associated with
dilated cardiomyopathy. By reducing hypervolemia and by venous dilatation,
diuretics lower preload and afterload. This leads to relief of congestion and termination of the vicious cycle of
congestive heart failure. Accordingly, the prognosis of
dilated cardiomyopathy might be improved by
diuretics. There are numerous
diuretics acting differently on the renal tubules, the choice of which depends on the renal function and serum
electrolyte concentrations. Reduction of preload and afterload improves
congestive heart failure as has been demonstrated repeatedly. Many substances have therefore been used for arterial and venous dilation with differing results. At least for short-term periods, congestion is reduced and cardiac output increases. Especially inhibitors of
angiotensin II converting
enzyme are very effective since they act both in the arterial and venous systems. Additionally, inhibition of the action of
angiotensin may be regarded as causal
therapy since the renin-angiotensin system is the trigger for vasoconstriction and fluid retention in
congestive heart failure. Unlike other substances,
ACE inhibitors have been demonstrated to improve prognosis of patients with
congestive heart failure. At present, combined
diuretic therapy and
angiotensin conversion
enzyme inhibition would seem the most reasonable treatment for patients with
dilated cardiomyopathy and sinus rhythm. If
atrial fibrillation and
tachyarrhythmia develop, additional digitalis
therapy is effective.