Cardiomyopathy

Overview

Cardiomyopathy is a disease of the heart muscle that makes it harder for the heart to pump blood to the rest of the body. It can lead to heart failure. The main types of cardiomyopathy include dilated, hypertrophic, and restrictive cardiomyopathy. Treatment depends on the type of cardiomyopathy and how serious it is. Symptoms may include breathlessness, swelling of the legs and ankles, cough, chest discomfort, and fatigue. The cause of cardiomyopathy is often unknown, but it can be acquired or inherited. Acquired cardiomyopathy can be caused by high blood pressure, heart tissue damage, rapid heart rate, heart valve problems, COVID-19 infection, metabolic disorders, lack of essential vitamins or minerals, pregnancy complications, hemochromatosis, sarcoidosis, amyloidosis, or connective tissue disorders. Hypertrophic cardiomyopathy is a specific type where the heart muscle becomes thickened, and it can cause shortness of breath, chest pain, or changes in the heart's electrical system.

Understanding the disease

Symptoms

The symptoms of cardiomyopathy include breathlessness with activity or even at rest, swelling of the legs, ankles, and feet, bloating of the abdomen due to fluid buildup, cough while lying down, difficulty lying flat to sleep, fatigue, heartbeats that feel rapid, pounding, or fluttering, chest discomfort or pressure, dizziness, lightheadedness, and fainting. Symptoms tend to worsen if left untreated.

Risk Factors

Risk factors for developing cardiomyopathy include: family history of cardiomyopathy, heart failure, or sudden cardiac arrest; long-term high blood pressure; conditions affecting the heart such as past heart attacks, coronary artery disease, or infection in the heart; obesity; long-term alcohol misuse; illicit drug use; certain chemotherapy drugs and radiation for cancer; and various diseases such as diabetes, thyroid disease, hemochromatosis, amyloidosis, sarcoidosis, and connective tissue disorders.

Development

The various types of cardiomyopathy can develop due to different causes. Here's a summary of how some of the common types of cardiomyopathy develop:

1. Dilated Cardiomyopathy: This type most often occurs due to coronary artery disease or heart attack, but it can also be caused by genetic changes. In some cases, the cause is unknown.
2. Hypertrophic Cardiomyopathy: This type often has a genetic component, and many people with this condition have a family history of the disease. Some genetic changes have been linked to hypertrophic cardiomyopathy.
3. Restrictive Cardiomyopathy: The cause of this type is often unknown (idiopathic), but it can also be caused by a disease elsewhere in the body that affects the heart, such as amyloidosis.
4. Arrhythmogenic Right Ventricular Dysplasia: This rare type of cardiomyopathy is typically caused by genetic changes. It's important to note that the specific cause of cardiomyopathy may not always be identified, and some types may develop without an apparent cause.

Assessment and Diagnosis

Triage

You should see a doctor if you have one or more signs or symptoms associated with cardiomyopathy. This includes experiencing chest pain, a fast, fluttering, or pounding heartbeat, shortness of breath during activity, swelling of the legs, ankles, and feet, a cough while lying down, difficulty lying flat to sleep, fatigue, heartbeats that feel rapid, pounding, or fluttering, chest discomfort or pressure, dizziness, lightheadedness, and fainting. If you have severe difficulty breathing, fainting, or chest pain that lasts for more than a few minutes, call 911 or your local emergency number. If you have a first-degree relative with hypertrophic cardiomyopathy, you might be referred for genetic testing to screen for the condition.

Diagnosis

To diagnose cardiomyopathy, your healthcare provider will perform a physical examination, ask questions about your personal and family medical history, and may order several tests, including:

1. Echocardiogram: This test uses sound waves to create images of the heart and can reveal if the heart's muscle is unusually thick, enlarged, or if there are any issues with heart valves.
2. Electrocardiogram (ECG or EKG): This test measures electrical signals from the heart and can show disturbances in the heart's electrical activity, irregular heart rhythms, or signs of heart thickening.
3. Blood tests: Different blood tests can be done to check for infections, substances, or diseases that may lead to cardiomyopathy.
4. Chest X-ray: A chest X-ray can show the shape and condition of the heart and lungs and may reveal fluid in or around the lungs.
5. Exercise stress test: This test assesses how the heart responds to physical activity and can help diagnose heart rhythm disease or reduced blood flow.

Management and Treatment

Complications

Potential complications of cardiomyopathy include heart failure, blood clots, heart valve problems, cardiac arrest, and sudden death. Cardiomyopathy can also lead to arrhythmias, leaky heart valves, and sudden cardiac arrest. Other complications may arise from long-term high blood pressure, neuromuscular disorders, and certain diseases, such as diabetes, thyroid disease, hemochromatosis, amyloidosis, sarcoidosis, and connective tissue disorders.

Home Remedies

It is important to consult with a healthcare professional for appropriate treatment and management of cardiomyopathy.

Treatment

The treatments for cardiomyopathy depend on the type and severity of the condition. Treatment options may include medications, surgically implanted devices, heart surgery, or, in severe cases, a heart transplant. Medications may include diuretics to reduce fluid buildup, ACE inhibitors to improve heart function, and beta blockers to lower blood pressure and decrease heart rate. Surgically implanted devices, such as pacemakers or implantable cardioverter-defibrillators (ICDs), may be used to control abnormal heart rhythms or improve heart function. Heart surgery may be necessary to repair or replace damaged heart tissue or to implant a device that helps the heart pump blood more efficiently. In severe cases, a heart transplant may be considered as a last resort. Cardiomyopathy prevention focuses on maintaining a healthy lifestyle, including avoiding alcohol and tobacco, eating a healthy diet, getting regular exercise, managing stress, and controlling high blood pressure, high cholesterol, and diabetes.

Preparing for medical consultation

To prepare for an appointment for cardiomyopathy, you should:

1. Be aware of any pre-appointment restrictions and ask your provider if there's anything you need to do in advance, such as restricting your diet.
2. Write down your symptoms, including any that may seem unrelated to cardiomyopathy, and when they began.
3. List key personal information, such as a family history of cardiomyopathy, heart disease, stroke, high blood pressure, or diabetes, and any major stresses or recent life changes.
4. Make a list of all medications, vitamins, or other supplements you take, including doses.
5. Bring a family member or friend along to help you remember the information provided during the appointment.
6. Prepare to discuss your diet and exercise habits, as well as any questions you have for your healthcare provider. Some basic questions to ask your provider during the appointment include:

• What's the most likely cause of my symptoms?
• What are other possible causes?
• What tests do I need?
• What treatment options are available, and which do you recommend for me?
• How often should I be screened?
• Should I tell my family members to be screened for cardiomyopathy? Remember to follow your healthcare provider's advice on diet, exercise, and medications to manage your cardiomyopathy effectively.