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My dog has been diagnosed with DILATED CARDIOMYOPATHY

Dilated cardiomyopathy (DCM) is a disease of the heart muscle in which it becomes weak and is no longer able to contract properly. As a result, the heart becomes dilated and hence the name dilated cardiomyopathy.

DogWhat causes DCM ?

There are several reasons why the heart muscle may become weak such as infectious disease and low thyroid hormone levels among others. If the heart is forced to work harder for a long time due to another cardiac disease or faster (arrhythmias), the heart muscle may also become weak and lead to dilation. All of these conditions look like DCM and have to be excluded before a definite diagnosis of DCM may be issued. Complete understanding of the cause or causes of DCM is still not within our grasp. A genetic cause has been identified or is strongly suspected for a few breeds.

large and small dog

ffected breeds

DCM is more common in large breed dogs with a few exceptions such as Cocker Spaniels and Dalmatians.

  • Doberman
  • Great Dane
  • Irish Wolfhound
  • Newfoundland
  • Portuguese water dogs
  • Onset and natural progression
DCM in dogs is an adult onset disease - often around 5-7 years - except in the Portuguese water dog. Most of the information available refers to the Doberman breed and the disease may be roughly divided into 3 stages:
Stage 1
- dogs with the disease but without any signs of heart disease

Stage 2
(Occult Disease) - evidence of disease (heart dilation and/or irregular heart beats) but no clinical signs (lasts 2-4 years)

Stage 3
(Overt Disease) - clinical signs of heart failure

Diagnosis

Diagnosis for DCM

Overt stage Heart muscle "weakness" and enlargement of the heart may be easily identified on an ultrasound scan of the heart - echocardiographic examination. Other diseases are also excluded with this exam. A 24-48 hour electrocardiogram - Holter examination - allows proper assessment of the heart rate and rhythm to diagnose and manage arrhythmias which are frequent in this disease. Chest radiographs allow identification of signs of congestive heart failure - fluid in the lungs or chest cavity. Blood pressure measurement and blood tests to assess kidney function and electrolytes complete the necessary information to appropriately manage this disease.

Occult stage

Diagnosis of DCM in dogs in the occult stage constitutes a challenge. Yearly examinations with echocardiography and Holter monitoring are advised in predisposed breeds in order to try to identify affected dogs at a very early stage.

"Any signs of arrhythmia, heart murmur or heart enlargement should prompt a cardiovascular examination in any dog"

Unfortunately, identification of affected dogs that are still normal but go on to develop the disease later in life is still not possible.

Treatment

Unfortunately a cure does not exist for this condition. A combination of drugs is used to control signs of congestive heart failure and prolong life with the best quality of life possible.

Overt stage

Furosemide - to excrete the excess fluids in the body and treat congestive heart failure
ACE inhibitor - to counteract fluid retention by the kidneys and dilate the blood vessels and lessen the load on the heart
Pimobendan - to improve heart muscle strength and dilate the blood vessels and lessen the load on the heart
Digoxin - to improve heart muscle strength and control heart rate Occult stage
Significant arrhythmias may warrant therapy with anti-arrhythmic drugs. A delay in onset of heart failure and improved survival may be achieved with therapy with ACE inhibitors and pimobendan.

Occult stage

Significant arrhythmias may warrant therapy with anti-arrhythmic drugs.
A delay in onset of heart failure and improved survival may be achieved with therapy with ACE inhibitors and pimobendan.

Monitoring

Overt stage

Regular examinations will be necessary to appropriately manage DCM in dogs at this stage.

What will happen during a re-examination?

Dog with nurse

At each visit you will be asked a number of questions to assess how your dog is coping with treatment and with the condition. After being examined, blood pressure will be measured and an echocardiographic examination and thoracic radiographs will normally be repeated. Some blood tests will be essential to assess how the kidneys are coping with treatment and disease and also provide further important information needed for treatment adjustments. Regular Holter examinations will probably also be necessary.

Treatment adjustments

After any treatment adjustments a brief recheck at your vet may be necessary. The same blood tests will be repeated to assess the kidneys response to therapy, blood pressure and eventually chest x-rays if there has been previous congestive heart failure. Usually this is performed 5-10 days after the initial examination.

Occult stage

Yearly examinations with an echocardiographic examination and Holter examination.

Prognosis

dogsOvert stage

Depending on response to therapy, some dogs may cope well with the disease for a fair amount of time whereas others unfortunately do not. This varies with each case and is very difficult to predict. Sudden death is possible, especially in the Doberman.

Occult stage

This stage may last for up to 4 years or more in which no external signs of disease are perceived. Some dogs will die suddenly during this stage without ever showing clinical signs up to that point. This is more common in the Doberman breed.


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