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The cause of the initial damage is often not found, but may include:

• Ischemic heart disease with decreased blood flow to your heart
• Infections, usually viral
• Chronic exposure to toxins, including alcohol and some chemotherapy drugs
• A rare complication of pregnancy or childbirth (probably immune-related)
• Rarely, other illnesses, including rheumatoid arthritis, diabetes, or thyroid disease

Causes may include:

• Inherited (sometimes present at birth but often developing in teens)
• Aging, associated with hypertension

Causes are usually related to another condition, such as:

• Amyloidosis—Protein fibers collect in the heart
• Sarcoidosis—Small inflammatory masses (granulomas) form in many organs
• Hemochromatosis—Too much iron in the body

Changes to eliminate anything that adds to the disease or worsens symptoms:

• Avoid alcohol.
• If you are overweight, lose weight.
• Eat a low-fat diet to reduce the risk and extent of coronary artery disease.
• Limit salt intake to reduce fluid retention.
• Follow your doctor's advice about exercise. You may need to limit physical activity.

Medications may include:

• Diuretics—To remove extra fluid
• Angiotensin-converting enzyme (ACE) inhibitors—To relax blood vessels, lower blood pressure, and decrease the heart's workload
• Angiotensin receptor blockers—Similar to ACE inhibitors
• Hydralazine and isosorbide dinitrate—May be used with ACE inhibitors
• Digitalis—To slow and regulate heart rate, and slightly increase its force of contractions
• Beta-blockers—To slow the heart and limit disease progression
• Spironolactone—To improve outcome in people with dilated cardiomyopathy and advanced symptoms

Surgical options include:

• A pacemaker may be implanted to improve heart rate and pattern.
• For people with hypertrophic disease, doctors may remove part of the thickened wall that separates the heart's chambers. Surgery may be needed to replace a heart valve. Another option is alcohol septal ablation. This procedure reduces symptoms and improves how the heart functions.
• For those with life-threatening, irregular heart rhythms, a cardioverter defibrillator may need to be implanted.
• A heart transplant may be possible for otherwise healthy patients who do not respond to medical treatment. Candidates often wait a long time for a new heart. Those waiting may temporarily receive a ventricular assist device. This is a mechanical pump that takes over some of or most of the heart's pumping function.