5th July 2026

Management

General Management 

Generally speaking, patients with diagnosed DCM should restrict dietary intake of fluid (<1.5-2L fluid/day) and sodium (<5g/day). This is in addition to avoiding obvious precipitants such as alcohol and recreational drugs. Those with acquired causes of DCM require prompt treatment of the underlying metabolic, infective, endocrinological or electrolyte abnormality. 

High-intensity exercise, including competitive sport, is not recommended in symptomatic individuals, those with a left ventricular ejection fraction ≤40%, exercise-induced arrhythmias, or pathogenic variants in LMNA or TMEM43. 

Medical Management 

All patients with DCM should be treated according to established guidelines for the treatment of chronic heart failure. ACE inhibitors/angiotensin receptor blocker (ARB), angiotensin receptor-neprilysin inhibitor (ARNi), beta-blocker, mineralocorticoid receptor antagonist (MRA) and sodium-glucose co-transporter-2 (SGLT2) inhibitors are recommended to reduce hospitalisation and mortality. Moreover, loop diuretics provide symptomatic relief from fluid overload. 

Anticoagulation is advised in DCM patients with coexistent atrial fibrillation according to CHA2DS2-VA score to reduce thromboembolic risk. 

Patients with peripartum cardiomyopathy have a 50% chance of spontaneous recovery after delivery. However, they should be counselled regarding risk of potential recurrence even with recovery of LV function. Pregnancy is not advised in women with peripartum cardiomyopathy or DCM if LV function does not normalise. Beta-blockers and loop diuretics should be initiated carefully to the maximum tolerated dose while avoiding teratogenic agents (ACE inhibitors, ARB, ARNi, MRA) in this cohort of patients. 

Surgical Management

• ICDs
  • Patients with DCM and a high risk of sudden cardiac death, as determined by clinical risk stratification including cardiac risk factors, high-risk genotypes (especially so in those with LVEF=<35%), LVEF =<35% or in cardiac arrest or VT with haemodynamic compromise, may undergo implantation of an ICD for primary or secondary prevention of ventricular arrhythmias. However, particularly in young patients, ICDs can have several complications and may require multiple replacements.
• Cardiac Resynchronisation Therapy (CRT)/Biventricular pacing
  • CRT/biventricular pacing may be indicated in DCM patients with evidence of electrical dys-synchrony (e.g., widened QRS complex) and symptomatic heart failure despite optimal medical therapy.
• Heart Transplantation
  • Heart transplantation is considered in end-stage DCM patients with refractory heart failure and poor prognosis despite optimal medical and surgical management. It offers the potential for long-term survival and improvement in quality of life.
• LVADs
  • LVADs may be used while awaiting heart transplantation in patients with advanced heart failure or used in patients unsuitable for heart transplantation.
• Surgical Ventricular Reconstruction (SVR)
  • In select patients with severe left ventricular dilation and dysfunction, SVR involves surgical removal of scarred or non-contractile myocardium, reshaping the left ventricle, and restoring ventricular geometry to improve cardiac function.