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Cardiomyopathy

Cardiomyopathy refers to diseases of the heart muscle. These diseases have many causes, signs and symptoms, and treatments.

In cardiomyopathy, the heart muscle becomes enlarged, thick, or rigid. In rare cases, the muscle tissue in the heart is replaced with scar tissue.

As cardiomyopathy worsens, the heart becomes weaker. It's less able to pump blood through the body and maintain a normal electrical rhythm. This can lead to heart failure or irregular heartbeats called arrhythmias. In turn, heart failure can cause fluid to build up in the lungs, ankles, feet, legs, or abdomen.

The weakening of the heart also can cause other complications, such as heart valve problems.

Overview

The types of cardiomyopathy are:

  • Hypertrophic cardiomyopathy
  • Dilated cardiomyopathy
  • Restrictive cardiomyopathy
  • Arrhythmogenic right ventricular dysplasia
  • Unclassified cardiomyopathy
Cardiomyopathy can be acquired or inherited. "Acquired" means you aren't born with the disease, but you develop it due to another disease, condition, or factor. "Inherited" means your parents passed the gene for the disease on to you. Many times, the cause of cardiomyopathy isn't known.

Cardiomyopathy can affect people of all ages. However, people in certain age groups are more likely to have certain types of cardiomyopathy. This article focuses on cardiomyopathy in adults.

Outlook

Some people who have cardiomyopathy have no signs or symptoms and need no treatment. For other people, the disease develops quickly, symptoms are severe, and serious complications occur.

Treatments for cardiomyopathy include lifestyle changes, medicines, surgery, implanted devices to correct arrhythmias, and a nonsurgical procedure. These treatments can control symptoms, reduce complications, and stop the disease from getting worse.

Some people who have cardiomyopathy never have signs or symptoms. Others don't have signs or symptoms in the early stages of the disease.

As cardiomyopathy worsens and the heart weakens, signs and symptoms of heart failure usually occur. These signs and symptoms include:

  • Shortness of breath or trouble breathing, especially with physical exertion
  • Fatigue (tiredness)
  • Swelling in the ankles, feet, legs, abdomen, and veins in the neck
  • Other signs and symptoms may include dizziness; light-headedness; fainting during physical activity; arrhythmias (irregular heartbeats); chest pain, especially after physical exertion or heavy meals; and heart murmurs. (Heart murmurs are extra or unusual sounds heard during a heartbeat.)

People who have cardiomyopathy but no signs or symptoms may not need treatment. Sometimes, dilated cardiomyopathy that comes on suddenly may go away on its own. For other people who have cardiomyopathy, treatment is needed. Treatment depends on the type of cardiomyopathy you have, the severity of your symptoms and complications, and your age and overall health. Treatments may include:

  • Heart-Healthy lifestyle changes
  • Medicines
  • Nonsurgical Procedures
  • Surgery and implanted devices
The main goals of treating cardiomyopathy include:
  • Controlling signs and symptoms so that you can live as normally as possible
  • Managing any conditions that cause or contribute to the disease
  • Reducing complications and the risk of sudden cardiac arrest
  • Stopping the disease from getting worse
  • High blood pressure or hypertension
Heart-Heathly Lifestyle Changes


Your doctor may suggest lifestyle changes to manage a condition that’s causing your cardiomyopathy including:
  • Heart-healthy eating
  • Aiming for a healthy weight
  • Managing stress
  • Physical activity
  • Quitting smoking
Medicines


Many medicines are used to treat cardiomyopathy. Your doctor may prescribe medicines to:
  • Balance electrolytes in your body. Electrolytes are minerals that help maintain fluid levels and acid-base balance in the body. They also help muscle and nerve tissues work properly. Abnormal electrolyte levels may be a sign of dehydration (lack of fluid in your body), heart failure, high blood pressure, or other disorders. Aldosterone blockers are an example of a medicine used to balance electrolytes.
  • Keep your heart beating with a normal rhythm. These medicines, called antiarrhythmics, help prevent arrhythmias.
  • Lower your blood pressure. ACE inhibitors, angiotensin II receptor blockers, beta blockers, and calcium channel blockers are examples of medicines that lower blood pressure.
  • Prevent blood clots from forming. Anticoagulants, or blood thinners, are an example of a medicine that prevents blood clots. Blood thinners often are used to prevent blood clots from forming in people who have dilated cardiomyopathy.
  • Reduce inflammation. Corticosteroids are an example of a medicine used to reduce inflammation.
  • Remove excess sodium from your body. Diuretics, or water pills, are an example of medicines that help remove excess sodium from the body, which reduces the amount of fluid in your blood.
  • Slow your heart rate. Beta blockers, calcium channel blockers, and digoxin are examples of medicines that slow the heart rate. Beta blockers and calcium channel blockers also are used to lower blood pressure.
  • Take all medicines regularly, as your doctor prescribes. Don’t change the amount of your medicine or skip a dose unless your doctor tells you to.
Surgery and Implanted Devices


Doctors use several types of surgery to treat cardiomyopathy, including septal myectomy, surgically implanted devices, and heart transplant.

Septal Myectomy

Septal myectomy is open-heart surgery and is used to treat people who have hypertrophic cardiomyopathy and severe symptoms. This surgery generally is used for younger patients and for people whose medicines aren’t working well.

A surgeon removes part of the thickened septum that’s bulging into the left ventricle. This improves blood flow through the heart and out to the body. The removed tissue doesn’t grow back. If needed, the surgeon also can repair or replace the mitral valve at the same time. Septal myectomy often is successful and allows you to return to a normal life with no symptoms.

Surgically Implanted Devices


Surgeons can place several types of devices in the heart to improve function and symptoms, including:
  • Cardiac resynchronization therapy (CRT) device. A CRT device coordinates contractions between the heart’s left and right ventricles.
  • Implantable cardioverter defibrillator (ICD). An ICD helps control life-threatening arrhythmias that may lead to sudden cardiac arrest. This small device is implanted in the chest or abdomen and connected to the heart with wires. If an ICD senses a dangerous change in heart rhythm, it will send an electric shock to the heart to restore a normal heartbeat.
  • Left ventricular assist device (LVAD). This device helps the heart pump blood to the body. An LVAD can be used as a long-term therapy or as a short-term treatment for people who are waiting for a heart transplant.
  • Pacemaker. This small device is placed under the skin of your chest or abdomen to help control arrhythmias. The device uses electrical pulses to prompt the heart to beat at a normal rate.
Heart Transplant


For this surgery, a surgeon replaces a person’s diseased heart with a healthy heart from a deceased donor. A heart transplant is a last resort treatment for people who have end-stage heart failure. “End-stage” means the condition has become so severe that all treatments, other than heart transplant, have failed.

Nonsurgical Procedure


Doctors may use a nonsurgical procedure called alcohol septal ablation to treat cardiomyopathy. During this procedure, the doctor injects ethanol (a type of alcohol) through a tube into the small artery that supplies blood to the thickened area of heart muscle. The alcohol kills cells, and the thickened tissue shrinks to a more normal size. This procedure allows blood to flow freely through the ventricle, which improves symptoms.