Treatment: Dilated Cardiomyopathy

Standard therapy of heart failure (Chap. 124. Heart Failure and Cor Pulmonale): Diuretic for volume overload, vasodilator therapy with ACE inhibitor (preferred), angiotensin receptor blocker or hydralazine-nitrate combination shown to limit disease progression and improve longevity. Add beta blocker in most pts. Consider aldosterone antagonist therapy for pts with class II-IV heart failure, and chronic anticoagulation if there is accompanying atrial fibrillation (AF), prior embolism, or recent large anterior MI. Antiarrhythmic drugs (e.g., amiodarone or dofetilide) may be useful to maintain sinus rhythm in pts with AF. Consider implanted cardioverter defibrillator for pts with ≥ class III heart failure and LVEF <35%. For those with persistent class III-IV heart failure, LVEF <35%, and QRS duration >120 ms, consider biventricular pacing. Possible trial of immunosuppressive drugs, if active myocarditis present on RV biopsy (controversial as long-term efficacy has not been demonstrated). In selected pts, consider cardiac transplantation.