Dilated Heart Failure: Understanding the Symptoms, Causes, Treatment & Prevention

Dilated heart failure is a complication of dilated cardiomyopathy (DCM), a type of heart muscle disease characterized by the gradual stretching, thinning and enlargement of the ventricles (heart chambers). As the heart muscle grows progressively weaker, it becomes more and more difficult for the heart to properly pump blood throughout the body effectively to meet the body’s demands. In instances when dilated cardiomyopathy leads the heart to this state, it’s known as dilated heart failure.

Dilated cardiomyopathy is a common heart disease that often impacts adults under the age of 50. The disease frequently starts in the left ventricle before spreading to the right ventricle and eventually to the atria. A person may not notice the signs of DCM at first, especially since the symptoms can appear similar to those of other conditions. If left untreated, however, it can become life-threatening and lead to dilated heart failure.

What Are the Causes and Risk Factors of Dilated Heart Failure?

Understanding the causes and risk factors of dilated heart failure begins with grasping that of the condition that precedes it: Dilated cardiomyopathy. Dilated cardiomyopathy is often idiopathic (meaning that the exact cause is unknown), but some potential causes of this underlying condition of dilated heart failure include:

• Heart valve disease, a type of structural heart disease
• Thyroid disease
• A viral or parasitic infection such as Chagas disease
• Coronary heart disease or heart attack
• High blood pressure
• Diabetes
• Excessive iron in the heart
• Obesity
• Excessive use of alcohol
• Using drugs that can be harmful to the heart, such as amphetamines and cocaine
• Exposure to environmental toxins, including cobalt

In some instances, dilated cardiomyopathy may be passed from one generation to another. Pregnancy and childbirth can also cause the condition, but it’s generally reversible. In general, dilated cardiomyopathy is more prevalent in men than in women. People of any age can develop this condition, though infants and young children with dilated cardiomyopathy are more likely to be misdiagnosed with a respiratory infection or other non-heart related condition.

What are the Symptoms and Warning Signs of Dilated Heart Failure?

Because dilated cardiomyopathy makes it difficult for the heart to pump blood, the resulting drop in oxygenated blood flow can cause someone with dilated heart failure to experience:

• Shortness of breath
• Persistent cough
• Fatigue
• Dizziness
• Swelling within the neck, abdomen, legs and feet
• Unexpected weight gain as a result of swelling
• Difficulty exercising
• Chest pain or discomfort
• Irregular or pounding heartbeat

Some individuals may not experience any signs of dilated cardiomyopathy in the early stages of the disease. As it progresses, symptoms typically worsen. It’s important to see a health care provider as soon as any signs of the condition are present, especially if you have persisting chest pain or severe difficulty breathing. Untreated dilated cardiomyopathy can lead to dilated heart failure, which is why seeking care from a doctor is essential for anyone experiencing the symptoms listed above.

Diagnosing Dilated Heart Failure

When diagnosing dilated cardiomyopathy—the underlying condition that can lead to the development of dilated heart failure—physicians will generally perform a physical examination and order tests such as:

• Blood tests – to check for diseases or infections that could point to or rule out dilated cardiomyopathy
• Cardiac catheterization – involves a long, thin tube filled with dye that is inserted into a blood vessel and guided toward the heart; the dye helps arteries appear clearly on X-ray scans.
• Chest X-rays – uses electromagnetic waves to show the heart and lungs; it can show the general condition and shape of the organs in addition to any fluid in or around the lungs
• Computed tomography (CT) scans – uses X-rays to create cross-sectional images of the heart’s pumping chambers; the size and function of the chambers can help determine a diagnosis of dilated cardiomyopathy
• Echocardiograms – uses sound waves to produce images of the heart and reveal how blood travels through the organ and its valves
• Electrocardiograms (EKGs or ECGs) – to test the electrical activity in the heart and determine whether the heart is beating too fast (tachycardia) or too slow (bradycardia)
• Magnetic resonance imaging (MRI) scans – is similar to a CT scan, but uses radio waves and magnetic fields to create the images of the heart’s pumping chambers
• Myocardial biopsies – to take a sample of heart tissue to check for muscle damage; a myocardial biopsy may be performed during cardiac catheterization
• Radionuclide studies, such as a MUGA scan – involves taking images after injecting a small amount of radioactive isotope to assess heart function and blood flow through the ventricles
• Exercise stress test – involves the patient exercising on a treadmill or stationary bike with a heart monitor attached to measure how the heart responds to the activity

In order to understand the cause of the condition, a health care provider may also ask questions about family history. This may help achieve an accurate diagnosis, as some forms of dilated cardiomyopathy can be genetic.

Treatment for Dilated Heart Failure

At Tampa General Hospital’s Heart and Vascular Institute, treatment for dilated heart failure caused by dilated cardiomyopathy will depend on how far a patient’s condition has progressed. Our physicians may recommend:

Lifestyle Changes

Adjustments to a patient’s lifestyle may be required to improve the heart’s overall health. Recommendations could include eating a low-sodium diet, exercising on a regular basis and quitting smoking.

Medications

Drugs can be used to treat dilated heart failure caused by cardiomyopathy, with the goal of improving cardiac function, relieving symptoms and preventing complications. Blood pressure medications, anti-arrhythmics, water pills, blood thinners and others may be prescribed.

Surgery

Ultimately, a surgical procedure may be necessary to help a patient’s heart to beat and pump blood throughout the body properly. Surgery could include:

• Placing a pacemaker or an implantable cardioverter defibrillator (ICD)
• Placing a mechanical circulatory support (MCS) device, such as a ventricular assist device (VAD)
• Repairing faulty heart valves
• Bypassing damaged areas of the heart
• Performing a heart transplant

What Are the Complications and Long-Term Effects of Dilated Heart Failure?

Dilated heart failure itself is the main potential complication of dilated cardiomyopathy. The heart may struggle to pump sufficient blood to fulfill the body’s demands, and if untreated, heart failure can become life-threatening.

Other complications include:

• Irregular heart rhythms (arrhythmias) - Structural changes in the heart’s size and shape can disrupt its natural rhythm.
• Heart valve regurgitation - The weakened heart muscle may prevent valves from closing fully, causing blood to leak backward through one or more heart valves.
• Sudden cardiac arrest - The condition may lead to a sudden stop in heart function.
• Blood clots - Blood pooling in the left ventricle can lead to clot formation, which, if released into the bloodstream, may obstruct blood flow to vital organs such as the heart and brain.

If dilated cardiomyopathy leads to blood clots, this can result in stroke, heart attack or damage to other organs. Additional complications, such as arrythmias, can further increase clot risk.

How to Prevent or Reduce the Risk of Dilated Heart Failure?

While some risk factors of dilated cardiomyopathy, such as genetic predisposition, are out of an individual’s control, there are many ways to help prevent or reduce the complications of the condition. Following healthy lifestyle habits is commonly recommended for preventing this form of heart disease and the potential for developing dilated heart failure as well.

The most common prevention methods include habits like:

• Avoiding or limiting alcohol
• Not smoking or using illegal drugs like cocaine
• Eating a healthy diet, particularly one low in sodium (salt)
• Maintaining a healthy weight
• Closely monitoring and managing other medical conditions like high blood pressure and diabetes
• Managing stress
• Getting regular exercise
• Getting enough sleep

These habits are easy to incorporate into your daily life and adjusting to healthy routines and general health care can help to achieve good overall health while helping to prevent heart disease. If you suspect that you may have developed dilated cardiomyopathy, speaking to your healthcare provider is an important first step to take. Your doctor can provide personalized advice on how to reduce your risk of having the condition evolve into dilated heart failure.

Living With Dilated Heart Failure

If you are diagnosed with dilated cardiomyopathy, your prognosis will depend on the cause and severity of the disease. With proper ongoing care and lifestyle changes, many people are able to return to work and regular daily activities after treatment. Advanced forms of the condition may require you to remain in the hospital until symptoms improve, especially if you experience dilated heart failure as a result of dilated cardiomyopathy.

While there is no cure for the condition, you can improve your general wellbeing by actively watching out for signs of potential complications, such as swelling and sudden weight gain. In addition, you should follow up with your healthcare provider several times a year, especially if you’ve had a pacemaker or implantable cardioverter-defibrillator placed.  Finally, committing to making healthy lifestyle changes and taking any medications as prescribed can also help to prevent dilated cardiomyopathy from worsening and evolving into dilated heart failure.

Dilated Heart Failure: Frequently Asked Questions (FAQs)

It’s common to have questions and concerns about dilated heart failure and the cardiomyopathy that precedes it, but Tampa General Hospital is here to help. Explore answers to a few frequently asked questions below:

What is Dilated Heart Failure?

Dilated cardiomyopathy, the underlying condition leading to dilated heart failure, can have various causes. Often, it’s idiopathic (no clear cause), but potential causes include heart valve disease, thyroid disease, certain infections, excessive alcohol use, drug use (like amphetamines or cocaine), environmental toxins or even genetic factors. Sometimes, pregnancy and childbirth can trigger dilated cardiomyopathy, though this is usually reversible.

What Are the Symptoms of Dilated Heart Failure?

Common symptoms of dilated heart failure include shortness of breath, fatigue, dizziness and swollen or enlarged veins in the neck, abdomen, legs and feet. These symptoms result from reduced blood flow and oxygen levels.

How is Dilated Heart Failure Diagnosed?

Physicians use various methods to diagnose dilated cardiomyopathy and assess heart health, such as blood tests, chest X-rays, CT scans, echocardiograms, EKGs, MRIs, myocardial biopsies and other specialized imaging tests.

What Treatments Are Available for Dilated Heart Failure?

Treatment depends on the severity of the condition. Options include lifestyle changes (such as a low-sodium diet, regular exercise and smoking cessation), medications to improve heart function and manage symptoms, and in some cases, surgery. Surgical interventions may involve implanting a pacemaker or defibrillator, repairing valves, bypassing damaged heart tissue or even undergoing a heart transplant if needed.

Can Dilated Heart Failure Be Prevented?

While some risk factors are beyond an individual’s control, adopting a heart-healthy lifestyle can help reduce the risk of complications. Avoiding excessive alcohol, not using harmful drugs and managing health conditions like thyroid disease can help. If you have a family history of dilated cardiomyopathy, regular check-ups may also be beneficial.

The TGH Difference for Dilated Heart Failure

Dilated cardiomyopathy causes the chambers of the heart to expand, decreasing the heart’s ability to pump blood and putting patients at risk for dilated heart failure. This condition affects each person differently, and the team at Tampa General Hospital’s Heart and Vascular Institute is ready to offer the personalized care that every patient deserves.

Our heart and vascular team collaborates closely to diagnose and treat patients affected by dilated heart failure, where the heart struggles to pump blood effectively. Recognized for our expertise and exceptional patient care, U.S. News and World Report deemed TGH One of the Nation’s Best Hospitals for Heart & Vascular Care, and High Performing for Heart Attack and Heart Failure, meaning we are ranked in the top 10% in the nation for 2024-25. Plus, we became the only hospital in Hillsborough County—and one of just 12 in Florida—to achieve full heart failure accreditation from the American College of Cardiology Accreditation Service in 2017. And we are the only hospital in the Tampa Bay region recognized by Becker's Hospital Review on its list of 100 Hospitals and Health Systems with Great Heart Programs.

We offer a comprehensive range of treatment options, including pacemakers, ICDs and mechanical circulatory support (MCS) devices to serve as solutions or bridge-to-transplant options for patients. If necessary, a heart transplant procedure at our Transplant Institute—one of the top 10 transplant programs in the country—may be recommended when device therapy is unsuccessful.

To learn more, call our Heart & Vascular team at (813) 844-3900 to schedule an appointment or email heart-vascular@tgh.org.