Cardiomyopathy
Basics
Cardiomyopathy is a serious condition in which the heart muscle becomes damaged and cannot pump blood adequately.
While serious, cardiomyopathy is relatively rare, affecting approximately 50,000 Americans. Usually symptoms do not appear until the disease has progressed. When they occur, symptoms include shortness of breath, fatigue, and heartbeat abnormalities.
There are three major forms of cardiomyopathy Figure 01.
Figure 01. Types of Cardiomyopathy
Causes
Dilated cardiomyopathy can occur as a result of infections, as a complication of pregnancy, and as a result of abusing certain drugs or alcohol. However, in approximately 80% of cases the cause remains a mystery.
Genes seem to be responsible for the heart thickening of hypertrophic cardiomyopathy.
An abnormal gene may be inherited from a parent, or a normal gene may mutate later in life. Researchers have identified at least four genes that may be involved in hypertrophic cardiomyopathy.
Restrictive cardiomyopathy is usually caused by one of three rare conditions.
Symptoms
Symptoms, including shortness of breath, fatigue, and heartbeat abnormalities, usually do not show up until cardiomyopathy is well-established.
People with cardiomyopathy may feel winded or tired after any amount of exertion, or may experience a pounding heart during physical activity. In some cases, the heart is so weak that the blood that cannot be pumped forward effectively backs up in the lungs, abdomen, or hands and feet. Some patients experience heart rhythm disturbances and feel dizzy or faint. Others may have chest pains or a severe cough. When an infection is present, fever and flu-like symptoms occur.
Symptoms of Cardiomyopathy
Risk Factors
Lifestyle factors and existing health problems can put you at risk for cardiomyopathy.
Risk is higher among smokers and people who are obese, and those with a family history of cardiomyopathy. Years of excessive alcohol intake can also increase a person’s risk for developing the problem. Anyone with a family history of cardiomyopathy should discuss safe forms of exercise with a doctor.
Gender and race can be risk factors for cardiomyopathy.
While the reason is unknown, restrictive cardiomyopathy occurs more frequently in tropical and subtropical Africa.
Dilated cardiomyopathy is most common among middle-aged African-American men. African-American women over 30 years of age are at increased risk for cardiomyopathy associated with childbirth.
Diagnosis
Cardiomyopathy is a serious condition in which the heart muscle becomes damaged and cannot pump blood adequately.
While serious, cardiomyopathy is relatively rare, affecting approximately 50,000 Americans. Usually symptoms do not appear until the disease has progressed. When they occur, symptoms include shortness of breath, fatigue, and heartbeat abnormalities.
There are three major forms of cardiomyopathy Figure 01.
Figure 01. Types of Cardiomyopathy
Dilated cardiomyopathy can occur as a result of infections, as a complication of pregnancy, and as a result of abusing certain drugs or alcohol. However, in approximately 80% of cases the cause remains a mystery.
Genes seem to be responsible for the heart thickening of hypertrophic cardiomyopathy.
An abnormal gene may be inherited from a parent, or a normal gene may mutate later in life. Researchers have identified at least four genes that may be involved in hypertrophic cardiomyopathy.
Restrictive cardiomyopathy is usually caused by one of three rare conditions.
Symptoms, including shortness of breath, fatigue, and heartbeat abnormalities, usually do not show up until cardiomyopathy is well-established.
People with cardiomyopathy may feel winded or tired after any amount of exertion, or may experience a pounding heart during physical activity. In some cases, the heart is so weak that the blood that cannot be pumped forward effectively backs up in the lungs, abdomen, or hands and feet. Some patients experience heart rhythm disturbances and feel dizzy or faint. Others may have chest pains or a severe cough. When an infection is present, fever and flu-like symptoms occur.
Symptoms of Cardiomyopathy
Lifestyle factors and existing health problems can put you at risk for cardiomyopathy.
Risk is higher among smokers and people who are obese, and those with a family history of cardiomyopathy. Years of excessive alcohol intake can also increase a person’s risk for developing the problem. Anyone with a family history of cardiomyopathy should discuss safe forms of exercise with a doctor.
Gender and race can be risk factors for cardiomyopathy.
While the reason is unknown, restrictive cardiomyopathy occurs more frequently in tropical and subtropical Africa.
Dilated cardiomyopathy is most common among middle-aged African-American men. African-American women over 30 years of age are at increased risk for cardiomyopathy associated with childbirth.
To determine what is causing your symptoms, your doctor will start with a medical history and do a physical examination.
In addition to asking you about chest pain, fatigue, shortness of breath, and any other symptoms you may be experiencing, your doctor will listen to your heart through a stethoscope for abnormal rhythms and sounds. Cardiomyopathy may cause the heart to beat too quickly or too slowly, or in an uncoordinated manner. Sometimes cardiomyopathy interferes with the ability of the heart valves to open and close properly, and a murmur can be heard. Listening to your breathing can reveal fluid in your lungs -- another indication that you might have cardiomyopathy. Your doctor will also take your blood pressure, which may be elevated because of hypertension, or lowered because of heart muscle weakness.
Your doctor will run several tests to study your heart before making a diagnosis.
Your doctor may wish to have a specialist perform a procedure called cardiac catheterization.
For this procedure, a long thin tube called a catheter will be inserted through an artery or vein (usually in an arm or leg) and threaded through a major vessel to your heart. Dye is then injected, and x-rays are taken to show the structure of the heart. This test is useful for looking for blockages in the arteries supplying the heart muscle, verifying the strength or weakness of the heart muscle, measuring pressures in the heart, and occasionally for collecting tissue samples (biopsies).
Genetic tests are useful for identifying patients with hypertrophic cardiomyopathy.
If you have a family history of cardiomyopathy, your doctor may recommend genetic testing. A small sample of your tissue will be sent to a laboratory to see if you have inherited an abnormal gene.
If anyone in your family has had cardiomyopathy or has died suddenly from heart disease, talk to your doctor about what tests you should have to check for the condition.
If you have a family history of hypertrophic cardiomyopathy, avoid exercising too much and avoid competitive sports. Your doctor will tell you what types of physical activities are safe.
Women who have had cardiomyopathy associated with pregnancy should discuss the risk of future childbearing with their doctor.
Prevention and Screening
If anyone in your family has had cardiomyopathy or has died suddenly from heart disease, talk to your doctor about what tests you should have to check for the condition.
If you have a family history of hypertrophic cardiomyopathy, avoid exercising too much and avoid competitive sports. Your doctor will tell you what types of physical activities are safe.
Women who have had cardiomyopathy associated with pregnancy should discuss the risk of future childbearing with their doctor.
Treatment
If you are suddenly short of breath, have chest pains, or faint during physical activities, seek immediate medical attention.
Cardiomyopathy is a serious medical condition. If you experience heart pounding, unexplained breathlessness, or sudden chest pain, see a doctor right away.
Talk to your doctor about specific diet, exercise, and weight loss measures that may help your condition.
If you have been diagnosed with cardiomyopathy, you should not drink any alcohol at all. Your doctor may also recommend that you lose weight if you are overweight, and that you eat a low-salt, low-fat diet that includes lots of fresh fruits and vegetables and whole grains. Because certain types of exercise can be dangerous for people with cardiomyopathy, talk to your doctor about what type of physical activity is right for you.
Your doctor is the best source of information on the drug treatment choices available to you.
If you have a serious heart rhythm disturbance that cannot be corrected with medications, you may need a procedure or a device to help regulate your heartbeat.
Some heartbeat abnormalities can be corrected with a controlled shock delivered to the chest, called cardioversion. During cardioversion, special paddles will deliver electrical shocks to your heart to help regulate your heartbeat. Cardioversion is performed under general anesthesia, and may get rid of symptoms and the need for anticoagulants. Sometimes an implanted device that delivers internal shocks is needed. Occasionally a pacemaker will be used to monitor and control heart rhythm.
If you have hypertrophic cardiomyopathy that is blocking blood flow and you don’t want surgery, you may want to consider a nonsurgical technique called alcohol ablation.
This new treatment involves injecting alcohol into a branch of an artery that leads to the heart. The alcohol destroys the excess heart muscle so that there is no need to remove it surgically. People who undergo this procedure may experience chest pain after the injection. In addition, alcohol ablation has been known to disrupt heart rhythm and necessitate a pacemaker. This is a new therapy that is only being done at a few centers around the country; it is still considered to be experimental.
In some cases of hypertrophic cardiomyopathy, surgery to remove part of the heart muscle (surgical myectomy) may ease discomfort.
For this operation, a surgeon will remove the part of your thickened heart that is blocking the blood flow--usually part of the muscular wall that separates the left and right ventricles (septum). At this time, you may need to have the heart valves that connect the heart’s upper and lower left chambers replaced or repaired as well. This eases symptoms in the majority of patients, but results in death in a few. About 5% of patients who undergo surgery will develop a slow heartbeat that needs to be corrected with a pacemaker.
If you have serious damage to your heart, you may need a heart transplant.
If medical treatments have not helped your condition, you may be a candidate for a heart transplant. Most recipients are younger than 60, and are in good health, aside from having a weak heart. In people with advanced disease who have a transplant, 75% of patients live 5 years or longer. Unfortunately, there is a lack of donor hearts, and many people are waiting to receive one.
Your doctor may give you antibiotics before you have dental work or surgery. This reduces the likelihood that you will develop an infection in the lining of your heart (endocarditis).
The outlook for people with cardiomyopathy varies.
Because symptoms usually do not show up until the disease is advanced, many patients become quite sick--although some will improve and remain stable for years.
You will need to go for regular checkups so your doctor can monitor your progress and adjust your treatments as needed.