What is Cardiomyopathy?

Cardiomyopathy (kahr-dee-oh-my-OP-uh-thee) is a disease that weakens and enlarges your heart muscle. There are three main types of cardiomyopathy — dilated, hypertrophic and restrictive — all of which affect your heart muscle. Cardiomyopathy makes it harder for your heart to pump blood and deliver it to the rest of your body. There are many causes of cardiomyopathy, including coronary artery disease and valvular heart disease. Cardiomyopathy can lead to heart failure.

Cardiomyopathy can be treated. The type of treatment you'll receive depends on which type of cardiomyopathy you have and how serious it is. Your treatment may include medications, surgically implanted devices or, in severe cases, a heart transplant.

Symptoms

Some people who develop cardiomyopathy have no signs and symptoms during the early stages of the disease. But as the condition advances, signs and symptoms usually appear. Cardiomyopathy symptoms
may include:

Breathlessness with exertion or even at rest
Swelling of the legs, ankles and feet
Bloating of the abdomen due to fluid buildup
Fatigue
Irregular heartbeats that feel rapid, pounding or fluttering
Dizziness, lightheadedness and fainting

No matter what type of cardiomyopathy you have, signs and symptoms tend to get worse unless treated. In certain people, this worsening happens quickly, while in others, cardiomyopathy may not worsen for a long time.

Causes

Most of the time, the cause of the cardiomyopathy is unknown. In some people, however, doctors are able to identify some contributing factors. Possible causes of cardiomyopathy include:

Long-term high blood pressure
Heart valve problems
Heart tissue damage from a previous heart attack
Chronic rapid heart rate
Metabolic disorders, such as thyroid disease or diabetes
Nutritional deficiencies of essential vitamins or minerals, such as thiamin (vitamin B-1), selenium, calcium and magnesium
Pregnancy
Excessive use of alcohol over many years
Abuse of cocaine or antidepressant medications, such as tricyclic antidepressants
Use of some chemotherapy drugs to treat cancer
Certain viral infections, which may injure the heart and trigger cardiomyopathy
Iron buildup in your heart muscle (hemochromatosis)

The three types of cardiomyopathy are:

Dilated cardiomyopathy. This is the most common type of cardiomyopathy. In this disorder, your hearts main pumping chamber — the left ventricle — becomes enlarged (dilated), its pumping ability
becomes less forceful, and blood doesn't flow as easily through the heart. Although this type can affect people of all ages, it occurs most often in middle-aged people and is more likely to affect men.

Some people with dilated cardiomyopathy have a family history of the condition.

Hypertrophic cardiomyopathy. This type involves abnormal growth or thickening of your heart muscle, particularly affecting the muscle of your heart's main pumping chamber. As thickening occurs, the
heart tends to stiffen and the size of the pumping chamber may shrink, interfering with your hearts ability to deliver blood to your body. Hypertrophic cardiomyopathy can develop at any age, but the condition tends to be more severe if it becomes apparent during childhood. Most affected people have a family history of the disease, and some genetic mutations have been linked to hypertrophic
cardiomyopathy.

Restrictive cardiomyopathy. The heart muscle in people with restrictive cardiomyopathy becomes rigid and less elastic, meaning the heart cannot properly expand and fill with blood between heartbeats. While restrictive cardiomyopathy can occur at any age, it most often tends to affect older people. It is the least common type of cardiomyopathy and can occur for no known reason (idiopathic). The condition may also be caused by diseases elsewhere in the body that affect the heart.


Western Medicine Treatment

The overall goals of treatment for cardiomyopathy are to manage your signs and symptoms, prevent your condition from worsening, and reduce your risk of complications. Treatment varies by which of the major types of cardiomyopathy you have.

Dilated cardiomyopathy

If you're diagnosed with dilated cardiomyopathy, your doctor may recommend medications, surgically implanted devices or a combination of both. The medications you may be prescribed include:


Angiotensin-converting enzyme (ACE) inhibitors to improve your hearts pumping capability, such as enalapril (Vasotec), lisinopril (Zestril, Prinivil), ramipril (Altace) and captopril (Capoten).

Angiotensin receptor blockers (ARBs) for those who can't take ACE inhibitors, such as losartan (Cozaar) and valsartan (Diovan).

Beta blockers to improve heart function, such as carvedilol (Coreg) and metoprolol (Lopressor, Toprol XL).

Digoxin (Lanoxin). This drug, also referred to as digitalis, increases the strength of your heart muscle contractions. It also tends to slow the heartbeat. Digoxin reduces heart failure symptoms and improves your ability to live with cardiomyopathy.

Diuretics. Often called water pills, diuretics make you urinate more frequently and keep fluid from collecting in your body. Commonly prescribed diuretics for heart failure include bumetanide (Bumex)
and furosemide (Lasix). The drugs also decrease fluid in your lungs, so you can breathe more easily. One diuretic, spironolactone (Aldactone), may also be helpful in treating scarring of your heart tissue.

Another option for some people with dilated cardiomyopathy is a special pacemaker that coordinates the contractions between the left and right ventricles (biventricular pacing). In people who may be at risk of serious arrhythmias, drug therapy or an implantable cardioverter-defibrillator (ICD) may be options. An ICD is a small device — about the size of a box of matches — implanted in your chest to continuously monitor your heart rhythm and deliver electrical shocks when needed to control abnormal, rapid heartbeats. The device can also work as a pacemaker.


Hypertrophic cardiomyopathy

Your doctor may recommend beta blockers to relax your heart, slow its pumping action and stabilize its rhythm. These medications include Lopressor or calcium channel blockers, such as verapamil (Calan, Isoptin). Medications are often the preferred treatment for hypertrophic cardiomyopathy.

If medications don't work, you may need surgery or a medical device to treat your condition. Options include:

Septal myectomy. This is an open-heart operation in which the surgeon removes part of the thickened, overgrown heart muscle wall (septum) that separates the two bottom heart chambers (ventricles). Removing part of this overgrown muscle improves blood flow and reduces mitral regurgitation. Myectomy is used if medications don't relieve symptoms. Most people who have symptoms and undergo myectomy have no further symptoms. This type of surgery is available only in medical centers that specialize in the treatment of hypertrophic cardiomyopathy.

Septal ablation. Also called septal alcohol ablation, this is a treatment in which a small portion of the thickened heart muscle is destroyed by injecting alcohol through a catheter into the artery supplying blood to it. There are possible complications with this procedure, including heart block — a disruption of the hearts electrical system — which requires implantation of a pacemaker. The long-term success of this procedure is not yet known, but it is becoming more commonly used.

Pacemaker implantation. A pacemaker is a small electronic device inserted under your skin that sends electrical signals to your heart to monitor and regulate your heartbeat. Surgery to implant the pacemaker is usually performed during local anesthesia and typically takes less than three hours. Pacemaker implantation is generally not as effective as surgical options, but it is sometimes used in older people who want to avoid more invasive procedures. Implantable cardioverter-defibrillator (ICD). This is a pager-sized device implanted in your chest like a pacemaker. An ICD continuously monitors your heartbeat. If a life-threatening arrhythmia occurs, the ICD delivers precisely calibrated electrical shocks to restore a normal heart rhythm. A small number of people with hypertrophic cardiomyopathy are at risk of sudden cardiac death because of abnormal heart rhythms. In these high-risk individuals, many doctors recommend the implantation of an ICD.


Restrictive cardiomyopathy

Treatment for restrictive cardiomyopathy focuses on improving symptoms. Your doctor will recommend you pay careful attention to your salt and water intake and monitor your weight daily. Your doctor may also recommend you take diuretics if sodium and water retention becomes a problem. You may be prescribed medications to lower your blood pressure and control fast or irregular heart rhythms.Many of the medications that doctors prescribe for cardiomyopathy may have side effects. Be sure to discuss these possible side effects with your doctor before taking any of these drugs.

Heart transplant

If you have severe cardiomyopathy and medications can't control your symptoms, a heart transplant may be an option. Because of the shortage of donor hearts, even people who are critically ill may have a long wait before having a heart transplant. In some cases, a mechanical heart assist device can help critically ill people as they wait for an appropriately matched donor. These devices, known as ventricular assist devices (VADs), can help blood circulate through your heart for months, or even years. A VAD may allow you to live outside the hospital while you wait. In some people who aren't candidates for a heart transplant, VAD therapy could be a long-term treatment option.


Adopted from mayoclinic.com