**3.3. Treatment**

Management of DCM begins with lifestyle modifications such as adequate rest, weight control, low sodium diet, fluid restriction, stopping alcohol intake and smoking, and less physical activity during periods of cardiac decompensation.

*Medical management*: The patients of DCM are at increased risk of pulmonary and systemic thromboembolisation due to stasis of blood in the dilated hypokinetic cardiac chambers. Anticoagulation therapy with warfarin or dabigatran is often indicated in these patients. The risk of embolisation is the highest in patients with atrial fibrillation, severe left ventricular dysfunction, a previous history of thromboembolism, or echocardiographic evidence of a mural thrombus. Other medications like angiotensin-converting enzyme inhibitors and angiotensin antagonists, diuretics, beta blockers, vasodilators, digoxin, antiarrhythmics, and statins can be prescribed to keep the condition under control.

Patients with a LVEF <30% and an intraventricular conduction defect with wide QRS complex ≥130 ms may lack synchronised contraction of both ventricles. Resynchronisation of right and left ventricle with biventricular pacing using a cardiac resynchronisation therapy device (CRT-D) can restore synchronous contraction of both ventricles, shorten the QRS interval, decrease left ventricular size and improve systolic function, stroke volume and the overall survival rate of patients.

Heart transplantation is the definitive treatment and the most common indication for transplantation in patients with DCM for both adults and children. Patients that are likely to benefit highly from a heart transplant include patients who were previously very active, <60 years of age who show intractable symptoms of congestive heart failure despite optimal medical therapy.
