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Mild Symptoms (Class II)

Mild Symptoms (Class II)

What are mild symptoms?

A person with Dilated Cardiomyopathy (DCM) may notice that they fatigue easier or have mild shortness of breath during usual physical activities. This may cause slight limitation, meaning they need to stop and rest sooner, or more often, during usual activities. A person may notice that they have no symptoms with some activities but have mild symptoms with more exertional activities. The degree of symptoms and limitations is largely based on an individual’s baseline physical condition. For example, a tennis player may notice that they get fatigued and slightly short of breath after one game, compared to six months earlier when they could play a full set without symptoms. A sedentary office worker may notice fatigue and shortness of breath walking two blocks to the bus stop now as compared to six months ago when they could walk the distance without symptoms. People with Class II symptoms often look quite healthy and their family and friends may not understand that they have mild limitations.

Most people with mild, or Class II, symptoms are still able to work. For a person with a job that requires a lot of exertion, they may need to modify activities to some degree so they have the stamina to work a full-time schedule. Other people with mild, or Class II symptoms, may not need any modification to their work, especially if they have a job that is not very exertional.

What are the treatments?

Treatment is recommended when there is reduced heart muscle function. Heart muscle function is measured by ejection fraction, or the percentage of blood pumped from the heart with each beat. A normal ejection fraction indicating normal heart contraction is 50% or more. There is universal agreement that drug treatment is indicated if the ejection fraction is less than 40%. It is somewhat controversial whether treatment is indicated for ejection fractions between 40 to 50%. Patients should discuss this with their cardiologist if they fall into this category.

Drugs are the primary treatment. Essential drugs are those classified as beta blockers; the other essential class of drugs are ACE-inhibitors or ARBs. Both classes of drugs work to block the activated hormonal and neural systems. They have been studied in thousands of patients and have been shown to improve the survival rate of people with DCM. In some people, these drugs may decrease the size of the heart and improve heart muscle function. An echocardiogram should be performed after a minimum of six months of optimal drug therapy to determine if medications are improving the ejection fraction and/or heart size. In addition to these categories of drugs, people may benefit from another class of drugs called diuretics, which help the kidneys eliminate excess fluid in your body. They are helpful if your symptoms are due to fluid retention.

If a person’s ejection fraction is 35% or less, and they have been on optimal drug therapy, they may be a candidate for an implantable cardiac defibrillator (ICD) to help prevent sudden cardiac death. This prophylactic, or preventive therapy, is an elective therapy; some people do not want this therapy, nor are they the best candidates for it. Patients should discuss this option with their cardiologist.

Will symptoms get worse over time?

This is hard to predict. For some people with DCM, symptoms will stay the same or improve slightly. While for others, symptoms may progress with time. Occasionally there are other people who may have an improvement in their symptoms to such a degree that they no longer have symptoms. What is predictable is that the chances of symptoms getting worse, and/or a person dying sooner, are much higher for people who do not take the essential medications.

Are there activities that should be avoided?

Usually there are no activities that should be avoided. Individuals should actually try to be as active as possible by carrying on with daily activities. If usual activities cannot be done without limitations, it should be reported to a healthcare provider. Mild limitations, which are stable and predictable, may be the person’s new baseline. In this case, they should not limit activities, just be aware, and may need to rest more often or to do activities slower.

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