Cardiomyopathy

What is Cardiomyopathy?

Cardiomyopathy is a common type of heart disease that affects 1 in 500 of the general population and up to 4% of all pregnant women. Cardiomyopathy is a group of conditions that weakens the heart muscle. Cardiomyopathy causes the heart to work harder, pumping blood to the rest of the body. Overwork can lead to heart failure and other organ damage. Cardiomyopathy can affect people of any age, race or sex. It is more common in men, African Americans and in people over age 65.

Types of Cardiomyopathies

• Alcohol-induced cardiomyopathy: Long-term heavy alcohol use weakens the heart muscle. This causes the heart change shape and increases the risk of heart failure.
• Arrhythmogenic right ventricular dysplasia (ARVD): Fat and scar tissue gradually build up in the right ventricle. This leads to irregular heart rhythms.
• Chemotherapy-induced cardiomyopathy: Some cancer treatments can damage the heart, which is called cardiotoxicity.
• Dilated cardiomyopathy: The heart’s main pumping chamber (left ventricle) becomes enlarged and weak. This makes the heart unable to pump effectively.
• Hypertrophic cardiomyopathy: The heart muscle thickens abnormally and makes it harder to pump blood properly.
• Ischemic cardiomyopathy: Blocked or narrowed arteries reduce blood supply, restrict blood flow and weakens the heart.
• Left ventricular non-compaction (LVNC): The lower left ventricle doesn’t develop properly. This makes the heart muscle weak. It also reduces the heart’s ability to pump blood.
• Peripartum cardiomyopathy: During the last trimester of pregnancy or within five months after delivery, the heart muscle can weaken.
• Restrictive cardiomyopathy: The muscles of the heart’s lower chambers stiffen and can’t fill with blood.
• Stress-induced cardiomyopathy: A temporary weaking of the heart muscle after sudden acute emotional distress. Also called broken heart syndrome or Takotsubo cardiomyopathy.
• Transthyretin amyloidosis cardiomyopathy (ATTR-CM): The left ventricle stiffens and weakens when damaged proteins produced by the liver build up in the left ventricle.
• Sarcoid Cardiomyopathy: Abnormal cells infiltrate the heart muscle, compromising function and possibly the electrical conduction of the heart.

Cardiomyopathy Causes

Cardiomyopathy can have a variety of causes.

• Amyloidosis: A buildup of amyloid protein in the heart.
• Autoimmune diseases: Caused by the body's immune system mistakenly attacking its own healthy cells, tissues or organs.
• Coronary artery disease: A buildup of plaque in the coronary arteries, narrowing or blocking the flow of blood to the heart.
• Diabetes: High blood sugar levels from not enough insulin or not responding to the insulin produced.
• Familial history: A family history of heart conditions.
• Genetic mutations: Changes to your DNA sequence that can cause genetic disorders.
• Heart inflammation: Swelling and inflammation of the heart and surrounding tissue.
• Hemochromatosis: When the body absorbs too much iron from food.
• High cholesterol: A high amount of fat in the blood (lipids). This increases heart attack risk.
• Long-term alcoholism or cocaine abuse: After long-term heavy use of alcohol or cocaine the heart’s shape can change. This can lead to heart failure.
• Myocarditis:  Viral infections that can lead to heart muscle inflammation and damage.
• Muscular dystrophy: A progressive muscle weakness and degeneration that can lead to cardiomyopathy and other heart conditions.
• Sarcoidosis: A rare, chronic inflammatory disease caused by an overreactive immune system that creates clusters of inflamed tissue.
• Thyroid disease: A condition caused when the thyroid does not make enough hormones.

Cardiomyopathy Prevention

Inherited types of cardiomyopathies can’t be prevented. Adopting a heart-healthy lifestyle can potentially prevent other types.

• Eat a balanced and heart-healthy diet.
• Get regular physical activity.
• Quit or avoiding smoking and drinking alcohol.

Signs and Symptoms

Some people may not experience symptoms depending on their form of cardiomyopathy. Others may only have symptoms as the condition gets worse. Symptoms usually get worse before treatment. For a few, cardiomyopathy may quickly become worse. See a cardiologist if you have any of these symptoms:

General symptoms can include:

• Chest pain, especially after physical activity or large meals
• Coughing while laying down
• Dizziness
• Fainting
• Fatigue
• Heart palpitations
• Shortness of breath with physical activity
• Stomach bloating from fluid buildup
• Swelling of the ankles, feet, legs, stomach area and neck veins

Cardiomyopathy Risk Factors

• Cancer treatments, including chemotherapy and radiation
• Diabetes
• Family history of cardiomyopathy, heart failure or cardiac arrest
• Heart conditions, including past heart attacks or infections in the heart
• High blood pressure
• High cholesterol
• Illicit drug use
• Long-term alcohol or drug abuse
• Obesity
• Pregnancy, preeclampsia, multiple fetuses
• Thyroid disease

Diagnosis

To diagnose cardiomyopathy, your doctor will ask about your medical history. They also ask about your family’s health history. The doctor will conduct a physical exam. If they suspect a heart condition, you may be referred to a cardiologist for evaluation and testing.

Breathing and Exercise Tests

Exercise stress test: This test measures how your heart responds while walking on a treadmill or pedaling a stationary bike. During the test you will be connected to an EKG machine. The EKG will monitor heart activity.

Heart monitoring: Using this portable device to record electrical activity in the heart. Monitoring is done over an extended period of time.

Imaging Tests

Cardiac CT: A CT scanner uses imaging from different angles. It uses that to build images of your heart with a computer. This scan provides your doctor with a detailed view of the heart’s structure. It can identify blockages and calcium deposits.

Chest X-ray: A chest X-ray is a non-invasive way to view the heart’s size and shape.

Echocardiogram (Echo): This is an ultrasound test. It determines the structure and function of your heart.

Electrocardiogram (EKG): An EKG test can tell your doctor if you have abnormal heart rhythm. It also can suggest if you have had a previous heart attack or can tell when someone is actively having a heart attack.

Heart MRI: An MRI provides detailed images of the heart without using radiation. It can show damage to any specific area, how well the heart’s chambers and valves function, and how blood flows.

Lab Tests

Blood tests: Blood tests can provide insights into how your heart is functioning, including measuring cholesterol. These tests may give context when combined with your medical history and family history.

Diagnostic Procedures

Cardiac catheterization: In this procedure, a long, narrow tube is inserted into a blood vessel in the leg or arm. Then it moves through the body to the coronary arteries. This test can diagnose blockages in the arteries.

Myocardial biopsy: This procedure removes a tissue sample from the heart. This sample is examined (biopsy). This type of biopsy can diagnose cardiomyopathy, heart cancer and infections.

Treatment

Some people with cardiomyopathy do not show symptoms. Some may not need treatment. Cardiomyopathy is typically progressive. There is no cure. Your cardiologist may recommend treatment to prevent your disease from progressing. Treatment can reduce symptoms and prevent the disease from getting worse.

Medications

Blood thinners: These medications help prevent blood clots.

Cardiac glycosides: These drugs improve heart strength and efficiency. They also treat a fast or irregular heartbeat.

Electrolyte-balancing drugs: These drugs are used to help regulate heart rhythm, blood pressure and heart function.

Statins: These and other drugs that lower cholesterol are used when diet and exercise changes have not reduced cholesterol levels enough.

Vasodilators: Medications that widen blood vessels to treat high blood pressure and heart failure.

Heart muscle relaxers: Medications including beta-blockers, calcium channel blockers, ACE inhibitors and some vasodilators can slow the heart rate, this reduces the heart’s workload. It relaxes the heart muscle and can improve overall function. 

Diuretics: these drugs remove excess sodium and fluid from the body to make it easier for the heart to work and reduce blood pressure.

Sodium-glucose cotransporter-2 (SGLT-2) inhibitors: This is a type of medicine that can lower blood pressure and improve heart function.

Procedures

Alcohol septal ablation
This procedure shrinks the muscle dividing the left and right lower chambers of the heart (the septum). It can help the heart work better. Septal ablation is only used to treat hypertrophic cardiomyopathy.

Catheter ablation
A cardiologist uses heat or cold to destroy small areas of heart tissue that are causing abnormal electrical signals. This creates scar tissue that blocks the faulty signals and helps restore a normal heart rhythm.

Medical devices
Surgically implanted devices help with arrhythmia and heart failure. These can include pacemakers, left ventricular assist devices and implanted cardioverter defibrillators. These devices can improve quality of life by reducing hospitalizations.

Septal myectomy
If you have hypertrophic cardiomyopathy with serious symptoms, your doctor may remove part of the thickened septum.

Heart transplant
If you have life-threatening symptoms or complications of cardiomyopathy and no other treatments have worked, your doctor may recommend a heart transplant. Your provider will closely monitor your health after the transplant. You will need to take medications for the rest of your life.

Lifestyle Management

Inherited types of cardiomyopathies can’t be prevented. Early diagnosis can help you make a plan to manage the condition. Lifestyle changes also can reduce the risk of developing other types. A healthy lifestyle can help patients control symptoms and prevent complications.

Lifestyle changes include:

• Avoiding alcohol, tobacco and other drugs
• Exercising regularly
• Maintaining healthy cholesterol
• Managing blood pressure
• Scheduling regular checkups with your doctor
• Taking all medications as prescribed

Clinical Trials

Clinical trials help determine new treatment options for diseases and conditions. Patients with have access to clinical trials. Speak to your doctor to determine if there is a trial that would work best for you.