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What is the cure for an enlarged left ventricle with reduced contraction?

Friday, 02 September 2005
Answered by: Dr. U. Kaul
Director, Interventional Cardiology & Cardiac Electrophysiology,
Batra Hospital,
New Delhi
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Q. Can you please give me information on a severely dilated left ventricle with moderate global systolic dyfuction? My sister has been diagnosed with this.

A.  The information available is rather scanty. Enlarged left ventricle with globally reduced contraction usually indicates a primary disorder of heart muscle termed as cardimyopathy. However disease of coronary arteries should be ruled out by appropriate tests, preferably non-invasive. I presume har mitral and aortic valves are normal, echocardiography is a good test to evaluate that. If there is no reversible element as happens in cardiomyopathy, medical management is the treatment of choice. Drugs like ACE Inhibitors, beta blockers, aldactone, digoxin are proven medicines. Patients with associated ECG features of LBBB and echo evdence of dyssynchrony (left and right ventricles not working in unison) also benefit by implanting a special pacemaker called bi-ventricular pacemaker. Endstage heart diseaee not responding to above given strategies is a candidate for heart transplantation, which is not an easy proposition, lack of donors being the main problem. Mechanical heart is an alternative theoretically but it is still in prelimenary trials. Stem cell therapy, an attractive concept, at present investigatonal and needs lot more scientific data. There has been some premature talk about it in the lay media. Medical treament is the best bet. It has clearly shown improved survival and improved symtoms.It has to be pursued aggressively with maximal tolerated dose of drugs under strict medical supervision.

A.  The information available is rather scanty. Enlarged left ventricle with globally reduced contraction usually indicates a primary disorder of heart muscle termed as cardimyopathy. However disease of coronary arteries should be ruled out by appropriate tests, preferably non-invasive. I presume har mitral and aortic valves are normal, echocardiography is a good test to evaluate that. If there is no reversible element as happens in cardiomyopathy, medical management is the treatment of choice. Drugs like ACE Inhibitors, beta blockers, aldactone, digoxin are proven medicines. Patients with associated ECG features of LBBB and echo evdence of dyssynchrony (left and right ventricles not working in unison) also benefit by implanting a special pacemaker called bi-ventricular pacemaker. Endstage heart diseaee not responding to above given strategies is a candidate for heart transplantation, which is not an easy proposition, lack of donors being the main problem. Mechanical heart is an alternative theoretically but it is still in prelimenary trials. Stem cell therapy, an attractive concept, at present investigatonal and needs lot more scientific data. There has been some premature talk about it in the lay media. Medical treament is the best bet. It has clearly shown improved survival and improved symtoms.It has to be pursued aggressively with maximal tolerated dose of drugs under strict medical supervision.

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