Dilated Cardiomyopathy

Dilated cardiomyopathy (DCM) is characterized by dilation and impaired contraction of the left ventricle or both ventricles. The heart muscle stretches and thins, weakening its pumping ability and leading to heart failure. Causes include genetic mutations (especially in titin, lamin A/C, and other structural proteins), viral myocarditis, alcohol use, chemotherapy toxicity, and autoimmune processes, though many cases remain idiopathic. The clinical course varies widely. Some patients stabilize with medical therapy including beta-blockers, ACE inhibitors or ARBs, and aldosterone antagonists. Others progress to advanced heart failure requiring more intensive interventions. For patients with severe, refractory heart failure, left ventricular assist devices (LVADs) provide mechanical circulatory support as a bridge to transplantation or as long-term destination therapy. LVAD patients face unique challenges, particularly with anticoagulation management, since these devices currently require warfarin to prevent pump thrombosis, and direct oral anticoagulants (DOACs) are not approved for use with mechanical devices.