Cardiomyopathy describes diseases of the heart muscle. According to the Centers for Disease Control and Prevention, it may affect approximately 1 out of every 500 adults.
Definition & Facts
There are three main types of cardiomyopathy: dilated cardiomyopathy, hypertrophic cardiomyopathy, and restrictive cardiomyopathy. The condition essentially makes it difficult for the heart to pump and push blood to the rest of the body, and can oftentimes lead to heart failure. It can be treated, and is treated based on what type of cardiomyopathy the patient has as well as the severity of the condition. This is done through the use of medications, devices that are implanted through surgery, and, in serious cases, heart transplants.
Symptoms & Complaints
- Swollen legs, ankles and feet
- General fatigue
- Difficulty catching breath whether it be from physical activity, or just sitting in place
- Fluid buildup in the abdomen that will result in it becoming swollen and bloated
- Irregular heartbeat, such as a fluttering, rapid, skipping, or pounding heartbeat
- Dizziness that may lead to fainting
- Pain in the chest around the heart
- Coughing while lying down
When these symptoms first present themselves, they may appear rather minor, but if time goes on without the condition being treated, the symptoms will get worse and worse. The speed at which they get worse is different for different people. If these symptoms do present themselves, even in a minor form, patients should seek medical care as soon as possible.
There are numerous causes and risk factors for cardiomyopathy. In some cases, the cause is clear, while in other cases, it is difficult to pinpoint a definitive cause. Possible causes are cocaine abuse, genetics, chronic high blood pressure, obesity, diabetes, over-consumption of alcohol, infections, tissue disorders, and chronic rapid heart rate.
In addition to dilated cardiomyopathy, hypertrophic cardiomyopathy, and restrictive cardiomyopathy, arrhythmogenic right ventricular dysplasia is another form of the disease. It is rare, resulting from the heart’s right ventricle being closed off by scar tissue, leading to problems with the heart’s rhythm.
Dilated cardiomyopathy is the most common type of the condition, and it is caused by the dilation of the heart’s primary pumping chamber, the left ventricle. When it dilates, it does a poor job of pumping blood out of the heart. Hypertrophic cardiomyopathy occurs when the heart muscle becomes thicker, making it difficult for the left ventricle to adequately pump blood. Restrictive cardiomyopathy results from the heart becoming rigid and not being able to properly expand and fill with blood.
Diagnosis & Tests
When being diagnosed for cardiomyopathy, doctors will ask the patient his or her medical history as well as his or her family’s medical history. A physical examination will also be performed. If the doctor believes that cardiomyopathy might be present, he or she will order a number of tests. An X-ray may be performed to see whether the heart has become enlarged.
Another test that may be used is an echocardiogram, in which the doctor will look at the patient’s heart as it beats. This will allow the doctor to check the valves of the heart and help determine whether the condition is present. An electrocardiogram may be performed to determine whether or not the heart is beating irregularly. In some cases, a treadmill cardiac stress test will be used to determine how the heart beats during physical activity.
MRIs and CT scans may also be used to assess heart size and function. Blood tests will also likely be run in order to determine whether the patient’s BNP levels have risen. BNP is a protein in the heart, and if it’s at a high level, it may suggest that the heart is under stress. Genetic testing can also be requested by the patient if he or she believes genetics might be the cause.
Treatment & Therapy
When cardiomyopathy is being treated, the main goal is to prevent the condition from worsening. This is done in different ways depending on what type of cardiomyopathy the patient has.
Dilated cardiomyopathy can be treated with medications and surgically implanted devices. Medications can help prevent further complications of the heart by improving the heart's pumping ability, slowing down heart rate, and keeping blood clots from forming. A surgically implanted device may be administered to regulate heart rhythm. An implantable cardioverter-defibrillator (ICD), in particular, may be inserted to monitor heartbeat and provide electric shock when needed.
For hypertrophic cardiomyopathy, medications and ICDs may also be used. In addition, septal myectomy may be performed to remove part of the heart that's restricting blood flow, and septal ablation may be performed to decimate part of the thickened heart, allowing for better blood flow. This is done by injecting alcohol into the arteries through a catheter.
Restrictive cardiomyopathy is treated by the patient watching his or her salt and water intake. By doing this and monitoring his or her weight, the patient may be able to reduce the risk of complications from the disorder.
In the case of arrhythmogenic right ventricular dysplasia, doctors may administer medications, an ICD, or radiofrequency ablation. Radiofrequency ablation is a procedure in which catheters are put into the patient's blood vessels, leading to the heart, where the catheter transmits electrodes that ultimately damage the part of the heart that's blocking blood flow. If none of these procedures prove worthwhile, patients may become a candidate for a heart transplant.
Prevention & Prophylaxis