Management

Patients should be advised to stop drinking because of:

• depressant effects of alcohol on heart muscle
• difficulty in diagnosing alcohol-induced cardiomyopathy

Treatment of cardiac failure:

• treatment with angiotensin converting enzyme (ACE) inhibitors and beta blockers in line with management of chronic cardiac failure
• diuretics for management of symptoms with congestion; digoxin may also be required

Anti-arrhythmic drugs:

• only necessary if symptomatic arrhythmias or ventricular ectopics are so frequent as to impair cardiac output
• amiodarone is the agent of choice

Anticoagulation:

• long-term anticoagulation is the rule rather than the exception for most patients
• is mandatory if there is co-existent atrial fibrillation

Other treatment options include cardiac transplantation and cardiomyoplasty.

Notes:

• if refractory symptoms and left bundle branch block then patient may benefit from a biventricular pacemaker (2)
• should be considered for an implantable cardioverter defibrillator
• patients with syncope (with or without documented ventricular arrhythmias) identifies a high risk cohort (2)
  
  

Reference:

1. British Heart Foundation (1999). Factfile 1/99, Dilated Cardiomyopathy.
2. Pulse (May 28th 2005): 54-61.