Cardiomyopathy is a condition where the heart muscle is abnormal. The main types of cardiomyopathy include dilated, hypertrophic and restrictive cardiomyopathy. Cardiomyopathy makes it harder for your heart to pump and deliver blood to the rest of your body. 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
In the early stages, people with cardiomyopathy may not have any signs and symptoms. But as the condition advances, signs and symptoms usually appear. Cardiomyopathy signs and 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
- Cough while lying down
- Fatigue
- Irregular heartbeats that feel rapid, pounding or fluttering
- Chest pain
- 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.
When to see a doctor
See your doctor if you have one or more of the signs and symptoms associated with cardiomyopathy. Call 911 or your local emergency number if you experience severe difficulty breathing, fainting or chest pain that lasts for more than a few minutes. Because the condition is sometimes hereditary, your doctor may advise that your family members be examined for cardiomyopathy.
CAUSES
Often, the cause of the cardiomyopathy is unknown. In some people, however, doctors are able to identify some contributing factors. Possible causes of cardiomyopathy include:
- Genetic conditions
- Long-term high blood pressure
- Heart tissue damage from a previous heart attack
- Chronic rapid heart rate
- Heart valve problems
- Metabolic disorders, such as obesity, thyroid disease or diabetes
- Nutritional deficiencies of essential vitamins or minerals, such as thiamin (vitamin B-1)
- Pregnancy complications
- Drinking too much alcohol over many years
- Use of cocaine, amphetamines or anabolic steroids
- Use of some chemotherapy drugs and radiation to treat cancer
- Certain infections, which may injure the heart and trigger cardiomyopathy
- Iron buildup in your heart muscle (hemochromatosis)
- A condition that causes inflammation and can cause lumps of cells to grow in the heart and other organs (sarcoidosis)
- A disorder that causes the buildup of abnormal proteins (amyloidosis)
- Connective tissue disorders
Types of cardiomyopathy include:
Dilated cardiomyopathy. This is the most common type of cardiomyopathy. In this disorder, the pumping ability of your heart's main pumping chamber — the left ventricle — becomes less forceful. The left ventricle becomes enlarged (dilated) and can't effectively pump blood out of 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. In others, dilated cardiomyopathy may occur as a result of certain conditions such as coronary heart disease, infection, chemotherapy, or drug or alcohol use. The cause may also be unknown (idiopathic).
Hypertrophic cardiomyopathy. This type involves abnormal thickening of your heart muscle, particularly affecting the muscle of your heart's main pumping chamber (left ventricle). The thickened heart muscle can make it harder for the heart to pump blood.
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 can't 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's the least common type of cardiomyopathy and can occur for no known reason (idiopathic).
COMPLICATIONS
Having cardiomyopathy may lead to other heart conditions, including:
- Heart failure. Heart failure means your heart can't pump enough blood to meet your body's needs. The thickened, stiffened or weakened heart muscle due to cardiomyopathy can become unable to pump or can stop blood from flowing out of the heart. Left untreated, heart failure can be life-threatening.
Blood clots. Because your heart can't pump effectively, you're more likely to have blood clots form in your heart if you have cardiomyopathy. If clots are pumped out of the heart and enter your bloodstream, they can block the blood flow to other organs, including your heart and brain.
To reduce your risk, your doctor may prescribe a blood thinner (anticoagulant medication), such as aspirin, clopidogrel (Plavix), apixaban (Eliquis), dabigatran (Pradaxa), rivaroxaban (Xarelto) or warfarin (Coumadin, Jantoven).
- Valve problems. Because people with cardiomyopathy have an enlarged heart, the heart valves may not close properly, leading to a backward flow of blood.
- Cardiac arrest and sudden death. Cardiomyopathy can lead to abnormal heart rhythms. Some of these heart rhythms are too slow to keep blood flowing through your heart effectively, and some are too fast to allow the heart to beat properly. In either case, these abnormal heart rhythms can result in fainting or, in some cases, sudden death if your heart stops beating effectively.
TREATMENTS AND DRUGS
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 major type of cardiomyopathy you have.
Dilated cardiomyopathy
If you're diagnosed with dilated cardiomyopathy, your doctor may recommend treatment including:
- Medications. Your doctor may prescribe medications to improve your heart's pumping ability and function, improve blood flow, lower blood pressure, slow your heart rate, remove excess fluid from your body or keep blood clots from forming.
Surgically implanted devices. If you're at risk of serious heart rhythm problems, your doctor may recommend an implantable cardioverter-defibrillator (ICD) — a device that monitors your heart rhythm and delivers electric shocks when needed to control abnormal heart rhythms.
In some cases, your doctor may recommend a pacemaker that coordinates the contractions between the right and left ventricles (biventricular pacemaker).
Hypertrophic cardiomyopathy
If you're diagnosed with hypertrophic cardiomyopathy, your doctor may recommend several treatments, including:
- Medications. Your doctor may prescribe medications to relax your heart, slow its pumping action and stabilize its rhythm.
- Implantable cardioverter-defibrillator (ICD). If you're at risk of serious heart rhythm problems, your doctor may recommend an ICD to monitor your heart rhythm and deliver electric shocks when needed to control abnormal heart rhythms.
- Septal myectomy. In a septal myectomy, your surgeon removes part of the thickened heart muscle wall (septum) that separates the two bottom heart chambers (ventricles). Removing part of the heart muscle improves blood flow through the heart and reduces mitral valve regurgitation.
- Septal ablation. In septal ablation, a small portion of the thickened heart muscle is destroyed by injecting alcohol through a long, thin tube (catheter) into the artery supplying blood to that area.
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