7th March 2024

Treatment

Dilated cardiomyopathies are typically treated as per standard medical therapy for heart failure. If there is a clear precipitant, then this should be treated if possible, otherwise there are conservative, medical and interventional treatments according to a range of parameters, including left ventricular ejection fraction as per standard heart failure guidelines.

All patients with symptoms of fluid overload should be considered for a diuretic, typically a loop diuretic in the first instance. For patients with reduced left ventricular ejection fraction, medications that they should be offered include: 

• ACE inhibitor/ Angiotensin receptor blocker/ Angiotensin receptor blocker + Neprolysin inhibitor (ARNI)
• Beta blockade 
• Mineralocorticoid receptor antagonist
• Sodium Glucose Transporter Type 2 Inhibitors

Interventional options include:

• Ablation for ventricular tachycardias
• Implantable cardiac defibrillator for those with DCM and a confirmed disease-causing mutation at high risk for sudden cardiac death
• Cardiac resynchronisation therapy +/- defibrillator – dependent upon ejection fraction, NYHA classification and QRS duration
• Left ventricular assist device – either as bridging to transplant or as destination therapy
• Cardiac transplant