Cardiomyopathy

Cardiomyopathy refers to a number of diseases that affect cardiac muscles.

The major types of cardiomyopathy are: dilated, hypertrophic and restrictive cardiomyopathy. Cardiomyopathy causes difficulties in myocardial contraction and affects blood supply. It is a treatable condition however, it may lead to heart failure if treatment is not started early. The type and severity of the disease determine which type of treatment you'll receive.

Treatments may include medications, lifestyle modifications, surgically implanted devices or, in severe cases, a heart transplant.

In its early stages, cardiomyopathy may remain asymptomatic. However, the signs and symptoms appear gradually as the disease progresses.

The signs and symptoms may include:

• Shortness of breath with exertion or even at rest
• Swelling of the legs, ankles and feet
• Abdominal distention
• Cough while lying down
• Fatigue
• Arrhythmia (rapid, pounding or fluttering)
• Chest pain
• Dizziness, lightheadedness and fainting

If left untreated, the signs and symptoms worsen irrespective of the type of cardiomyopathy. The rate at which these signs and symptoms worsen depends upon individual characteristics.

When to see a doctor?

Make an appointment with your doctor if you experience any signs and symptoms associated with cardiomyopathy. Signs like severe difficulty breathing, fainting or chest pain that lasts for more than a few minutes can indicate emergency conditions. In such case, call 911 or your local emergency number.

In most cases, the cause of cardiomyopathy is not explained though there may be various contributing factors.

Some possible causes of cardiomyopathy are:

• 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
• Certain vitamin or mineral deficiency, such as thiamin (vitamin B1)
• Pregnancy complications
• Chronic heavy drinking
• Use of cocaine, amphetamines or anabolic steroids
• Cancer chemotherapy and radiation therapy
• Iron deposition in your heart muscle (Hemochromatosis)
• An inflammatory condition in which clumps of cells grow in your heart and other organs (Sarcoidosis)
• A disorder in which abnormal proteins deposit in your tissues (Amyloidosis)
• Connective tissue disorders

Types of cardiomyopathy:

• Dilated cardiomyopathy: This type accounts for majority of the cases of cardiomyopathy. Reduced contractility owing to enlargement of the left ventricle causes marked reduction in the pumping capacity of your heart. Left ventricle is your heart’s major pumping chamber. Middle-aged males are more likely to be the victims of this condition and family history is a major risk factor. While in some people, dilated cardiomyopathy may occur secondary to coronary heart disease, infection, chemotherapy, or drug or alcohol use. Sometimes, the cause is not identified (idiopathic).
• Hypertrophic cardiomyopathy: This type is characterized by ventricular hypertrophy, especially the left ventricular wall is thickened. As a result, the heart cannot effectively pump the blood out to other parts of the body. It may affect people of any age but you are more likely to develop severe symptoms if you have this condition since your childhood. Your genes are to be blamed for making you prone to this condition.
• Restrictive cardiomyopathy: It’s a very rare condition in which your heart cannot expand properly due to rigid and less elastic heart muscles. This causes restrictive filling in the heart, hence the name Restrictive cardiomyopathy. It may affect people of any age but older people are the most likely victims. Sometimes, the cause cannot be determined (idiopathic). Other causative factors include:
• Hemochromatosis - a disease in which iron builds up in the heart muscles
• Amyloidosis - a disorder that causes the buildup of abnormal proteins, sarcoidosis - a disease that causes inflammation and can cause lumps of cells to grow in the heart and other organs,
• Eosinophilic heart disease - a disorder that causes abnormal blood cells to damage the heart.
• Arrhythmogenic right ventricular dysplasia: It is a rare inherited cardiomyopathy characterized by ventricular arrhythmia, caused by scarring of the muscles in right ventricle.

There are many other types of cardiomyopathy which are yet to be classified.

Making a diagnosis of Cardiomyopathy is done by performing several tests.

Visit your family doctor if you experience any related symptoms and/or have a family history of the condition. Your doctor may refer you to a specialist in disease of heart – a cardiologist. Be prepared for a clear and accurate conversation with your doctor with these tips:

What you can do?

Make a list of all the signs and symptoms. Don’t miss out key points including your family history of cardiomyopathy, heart disease, stroke, high blood pressure or diabetes, the medicines or supplements you are currently taking.

List out questions to ask your doctor. The list might include questions like:

• What could be the probable cause of my symptoms?
• Are there any specific foods that I should avoid?
• What to expect from your doctor?

Your doctor may ask:

• When was the first time you started experiencing symptoms? How severe are your symptoms?
• Do you have a family history of cardiomyopathy or any heart disease?

After a thorough physical examination, your doctor may recommend one or more of the following tests:

• Chest X-ray: Chest X-ray helps to show if your heart is enlarged.
• Echocardiogram: An echocardiogram creates images of your heart by picking sound waves that are bounced off when they hit your heart. Your doctor can use these images to determine any abnormality in your heart valves.
• Electrocardiogram (ECG): An ECG measures electrical impulses from your heart which make specific pattern under normal conditions. An abnormal ECG report can show problems with electrical activity of your heart that may indicate abnormal heart rhythms and areas of injury.
• Treadmill stress test: This test helps to determine the effects of physical stress on your heart functions like heart rhythm, blood pressure and exercise capacity.
• Cardiac catheterization: A thin tube called catheter is inserted through your blood vessels, generally in the groin area, that leads to your heart. The process is carried out by using X-rays as a guide. Coronary angiogram can also be done during cardiac catheterization. In coronary angiogram, a dye visible in X-rays is injected into your blood vessels so that your blood vessels show up on X-rays. This test may be used to rule out any blockages in your blood vessels. Your doctor may scrap a sample of tissues of your heart for further analysis in the laboratory (Biopsy).
• Cardiac magnetic resonance imaging (MRI): This imaging technique uses magnetic fields and radio waves to create detailed, both still and moving, images of your heart.
• Cardiac computerized tomography (CT) scan: This imaging technique uses X-rays to create images of your heart and its blood vessels. These images can be used to determine the heart size and function and assess heart valves.
• Blood tests: Your blood may be tested for determining your kidney, thyroid and liver function, iron levels. Also, your doctor can measure B-type natriuretic peptide (BNP) in your blood, a protein produced by your heart. Normally, BNP levels are low but conditions like heart failure, a common complication of cardiomyopathy, can put more stress on your heart causing BNP levels to rise.
• Genetic testing or screening: Genes could put you at greater risk factor of cardiomyopathy. Talk to your doctor about how genetic testing could help you and your family. Your doctor may recommend family screening or genetic testing for your first-degree relatives (parents, siblings and children).

Treatment depends upon the type of cardiomyopathy. The treatment goals could range from managing your signs and symptoms to reducing your risk of complications. 

Dilated cardiomyopathy

• Medications: Your doctor can prescribe medications like diuretics (to remove excess fluid from your body), cardiac glycosides (to improve your heart's contractility), beta blockers (to lower blood pressure) and anticoagulants (to keep blood clots from forming).
• Surgically implanted devices: If you're at risk of serious heart rhythm problems, you may be required to implant a cardioverter-defibrillator (ICD). ICD is a heart rhythm monitoring device that gives off electric shocks to control heart rhythm. In some cases, you may require a biventricular pacemaker, a pacemaker that synchronizes the contractions of left ventricle with the right ventricle.
• Hypertrophic cardiomyopathy
• Medications: Commonly used medications that relax your heart, check its pumping action and stabilize its rhythm may be prescribed.
• Implantable cardioverter-defibrillator (ICD): If you're at risk of serious heart rhythm problems, you may be required to implant a cardioverter-defibrillator (ICD). ICD is a heart rhythm monitoring device that gives off electric shocks to control heart rhythm.
• Septal myectomy: A portion of the thickened septal wall that separates the two ventricles may be removed surgically to reduce obstruction in blood flow and reduce mitral valve regurgitation.
• Septal ablation: It involves injection of alcohol to targeted portion of the thickened heart muscle using a catheter that delivers alcohol into the artery supplying to that area.

Restrictive cardiomyopathy

• Treatments are mostly targeted at alleviating the associated symptoms. Doctors recommend you to give special attention to your salt and water intake and monitor your weight daily. Diuretics that increase urine output, antiarrhythmic agents to control abnormal heart rhythms and medications to lower your blood pressure may be prescribed. Also, the treatment focuses on treating underlying disease, such as amyloidosis. Talk to your doctor about the possible side effects of the medications.
• Arrhythmogenic right ventricular dysplasia
• Implantable cardioverter-defibrillator (ICD): If you're at risk of serious heart rhythm problems, you may be required to implant a cardioverter-defibrillator (ICD). ICD is a heart rhythm monitoring device that gives off electric shocks to control heart rhythm.
• Medications: If you are not in condition have an ICD or your problems with frequent fast heart rhythms persist even if you have an ICD, you may be required to take medications to regulate your heart rhythm.
• Radiofrequency ablation: Radiofrequency ablation is considered if none of the other treatments prove successful in curbing the symptoms. Catheters are passed through your blood vessels to your heart. The electrodes present at the end of the catheters generate heat that destroys abnormal heart tissue responsible for abnormal heart rhythm.
• Ventricular assist devices: (VADs) Ventricular assist devices (VADs) or a mechanical pump can support heart function and blood flow. VADs are reserved for the patients for whom other less invasive methods have failed. The devices can be used for a long time or as a short-term treatment while waiting for a heart transplant.
• Heart transplant: When all the surgical and non-surgical methods have failed and you have end-stage heart failure, you can thinking of undergoing a heart transplant.

There are no sure shot ways to prevent cardiomyopathy. However, a few lifestyle changes and precautions might lower your risk.

Here are some recommendations for you:

Inform your doctor about family history, if you have any.

• Avoid alcohol or cocaine
• Keep your blood pressure, high cholesterol and diabetes under control
• Follow a healthy diet
• Exercise regularly
• Get enough sleep
• Manage stress

Follow a heart healthy lifestyle to better cope with Cardiomyopathy.

• Quit smoking
• Maintain a healthy weight
• Eat a healthy diet. Include a variety of fruits, vegetables and whole grains.
• Reduce your salt intake (less than 1,500 milligrams of sodium daily)
• Exercise: Consult your doctor which type fits you
• Don’t drink. If you drink, do it in moderation
• Manage your stress
• Get enough sleep
• Follow your doctor’s advice
• Don’t miss follow-up appointments.

There are several risks associated with cardiomyopathy, which include:

• Family history: A family history of cardiomyopathy, heart failure and sudden cardiac arrest puts you at a greater risk for cardiomyopathy
• High blood pressure: Prolonged hypertension is another major risk factor
• Conditions that affect the heart: If you have had heart attack, coronary artery disease or viral infections that affected your heart, you are at higher risk of cardiomyopathy.
• Obesity: Extra pounds put more stress on your heart and increase the risk of cardiomyopathy and heart failure.
• Alcoholism: It is found that the risk increases significantly after more than five years of drinking seven to eight drinks daily.
• Illicit drug use: Drugs, such as cocaine, amphetamines and anabolic steroids, may increase the risk of cardiomyopathy.
• Cancer treatments: Though inevitable, certain chemotherapy drugs can increase the risk of cardiomyopathy.
• Diabetes: Cardiomyopathy, heart failure and other heart problems could be a consequence of raised blood sugar.
• Thyroid disorders: Both hyper- and hypo- thyroidism can increase your risk of cardiomyopathy.
• Hemochromatosis: Dilated cardiomyopathy could result due to this disorder in which your body stores excess iron.
• Diseases that affect the heart: Diseases, such as, Amyloidosis - a disorder that causes the buildup of abnormal proteins, sarcoidosis - a disease that causes inflammation and can cause lumps of cells to grow in the heart and other organs, can increase your risk of cardiomyopathy.
• Complications
• Cardiac complications of cardiomyopathy include:
• Heart failure. Your heart muscles are thickened, weakened and stiffened in cardiomyopathy. Consequently, it fails to pump enough blood to meet your body's needs. Left untreated, heart failure can be life-threatening.
• Blood clots: Reduced blood flow due to cardiomyopathy could result in clots in your heart. Once in bloodstream, these clots can block the blood flow to heart and brain. You may be required to take blood thinner (anticoagulant), such as aspirin, clopidogrel or warfarin to lower the risk.
• Valve problems: The heart valves in people with cardiomyopathy may not close properly and result into backflow.
• Cardiac arrest and sudden death: Cardiomyopathy can lead to too slow or too fast heart rhythms. Such abnormal heart rhythm may cause fainting or, in some cases, sudden death if your heart stops beating effectively.