Treatment

• Treat the underlying cause of DCM: e.g., manage endocrine abnormalities, encourage abstinence from alcohol.

• Avoid cardiotoxic agents, if possible.

• Treat congestive heart failure, if present.

• In severe or refractory disease, consider:

  • AICD with or without cardiac resynchronization therapy

  • Left ventricular assist devices

  • Heart transplantation

• Congestive heart failure

  • Treat patients with DCM and heart failure with guideline-directed medical therapy.

  • Nonpharmacological measures include sodium restriction, smoking cessation, restriction of alcohol consumption, and exercise (if able).

• Thromboembolic events: anticoagulation

  • Indications: mechanical valves, intraventricular thrombus, and/or atrial fibrillation

  • Agents: warfarin, direct oral anticoagulants, heparins

• Consider device implantation in selected patients with persistently low LVEF on optimized medical therapy.

  • If symptomatic with LVEF ≤ 35%: AICD (to prevent sudden cardiac death due to ventricular fibrillation)

  • If symptomatic with LVEF ≤ 35%, sinus rhythm, and QRS > 150 ms: cardiac resynchronization therapy (to improve contractility)

  • See “Invasive interventions” in “Treatment of heart failure” for additional eligibility criteria.

• DCM refractory to medical therapy and device implantation: Consider heart cardiac transplantation.

DCM is the leading indication for heart transplantation.

• Heart failure

• Thromboembolism (e.g., stroke, pulmonary embolism, acute mesenteric ischemia)

• Arrhythmias (e.g., atrial fibrillation, ventricular tachycardia, ventricular fibrillation)

• Sudden cardiac death