Hospital therapy. Treatment and prevention of dilated cardiomyopathy (DCM) (most important)

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Hospital therapy. Treatment and prevention of dilated cardiomyopathy (DCM) (most important)

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10. Treatment and prevention of dilated cardiomyopathy (DCM)

The general principles for the treatment of DCM do not differ significantly from the treatment of chronic heart failure. In cases of secondary DCM, the treatment of the previous disease (valvular heart disease, etc.) is additionally carried out, and all measures are taken to eliminate the causes of DCM.

Peripheral vasodilators are quite effective, especially with concomitant anginal syndrome (nitrong, sustak, nitrosorbide). With anginal syndrome, it becomes necessary to use antianginal drugs, preferably prolonged nitrates (sustak, nitrong, nitrosorbide). Adrenoblockers are effective (they are prescribed in the absence of signs of heart failure).

Of the modern methods of surgical treatment of DCMP, the most effective is heart transplantation (transplantation). However, the possibilities of carrying out this operation are significantly limited. For this reason, as an alternative to heart transplantation in modern treatment, to increase the life expectancy of patients with DCMP, reconstructive surgeries have been developed and are being performed, which are aimed at eliminating insufficiency of the mitral and tricuspid heart valves. An alternative to heart transplantation in patients with DCM is partial removal of the left ventricle in order to reduce its size (Baptiste operation).

Not so long ago, for the treatment of patients with DCMP, special models of pacemakers were developed, they allow you to make the work of the ventricles of the heart synchronous. This leads to an improvement in the filling of the ventricles of the heart with blood and an increase in the pumping function of the heart.

DCM in children is 5-10 cases per 100 children per year. The greatest effect in the treatment of dilated cardiomyopathy in young children is achieved with a combination of corticosteroids and glycosides (prednisolone and digoxin). Against the background of monotherapy with prednisolone, a decrease in heart rate occurs. Monotherapy with digoxin leads to a decrease in tachycardia and dyspnea. Given the inadvisability of prescribing cytostatic drugs in young children, since a significant number of treatment complications were observed, it is more optimal in pediatrics to use long-acting cardiac glycosides in combination with corticosteroid hormones in dilated cardiomyopathy.

Prevention. Prevention of DCMP consists in the exclusion of alcohol, cocaine, as well as careful monitoring of cardiac performance during tumor chemotherapy.

It is useful to harden the body from an early age. Complete abstinence from alcohol in alcoholic DCM improves heart contractility and may eliminate the need for a heart transplant.

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