Dilated Cardiomyopathy

[Scott]

I have posted here before and I sincerely appreciate the insightful information that you have provided.

I am a very large man 400lbs (was 500lbs, but have lost 100lbs in the last year). In August of 1998 (when I weighed 500+lbs) I had a TEE to determine the cause of Atrial Fib. At that it was determined that I had dilated cardiomyopathy with an EF of 35-40%. All four chambers were dilated. I was advised by the attending general cardiologist and electrophysiologist that I needed to lose approximately 300lbs which I am on my way to doing. I was also advised to avoid alcohol, smoking, etc. For the most part I have maintained sinus rhythm, with only occasional bouts of AF lasting anywhere from 10 minutes to 5 hours. My blood pressure has been difficult to control, it has been in the 150/85 range most of the time. My current medication regime includes Toprol, Mavik, Rhythmol, Diazide, Lipitor, Coumadin, and Xanax-PRN. In July I returned for a follow-up TEE at that time I was informed that my heart had the same dimensions and that my EF was the same. I was told that next year a TEE would not be performed routinely as my condition appeared to be stable. I am for the most part asymptotic, but was frustrated that my condition had not improved somewhat with the weight loss (I understand that I remain morbidly obese) and exercise regime. The cardiologist explained that perhaps my cardiomyopathy was as a result of a viral infection and that it would not improve.

My questions are:
1. With continued weightloss is it a reasonable expectation that the cardiomyopathy and heart size will reverse/improve?

2. Given that there was no decrease in cardiac functioning nor increase in heart size, is it reasonable to expect that my condition even if it does not improve will remain stable?

3. I am confused by conflicting information, I have been told by several physicians (cardiologists included) that my cardiomyopathy and heart size is most likely a result of my obesity. Others have told me quite adamantly that obesity is not a cause of cardiomyopathy. Which of these statements is true?

4. Is there any other medications which may be more successful in helping to control my hypertension?

5. Any other suggestions which you feel may be beneficial or issue which I should address with my physician?

Thank you for providing such a valuable service!

[Cleveland Clinic, MD]

Congratulations on the weight loss.  Remember that it took a long time to get to the weight you are now at and it will take a long time to get it back down as well.  Work slowly and surely and make the lifestyle changes necessary.  No one has a crystal ball and can say for sure if the heart condition will improve but losing the weight will certainly give it the best chance.  As far as the cause it is also difficult to say.  A viral cause is a possiblity.  Given the severity of your obesity it is possible this is a cause although generally overwieght does not cause heart failure.  You may also have something like sleep apnea due to your weight that should be looked for and treated if present.  I would continue your current medical program and work on losing the weight.  Good luck.

[Scott]

In my previous posting I said "The cardiologist explained that perhaps my cardiomyopathy was as a result of a viral infection and that it would not improve." I must clarify that he actually said that "it MAY not improve."

[Cleveland Clinic, MD]

These things are always difficult to predict but the best thing is to improve all factors and hope for the best.