Cardiomyopathy – Diseases of the Heart Muscle

Cardiomyopathy generally refers to diseases which involve the heart muscle. Cardiomyopathy has several causes, signs & symptoms for which treatments are available. Basically cardiomyopathy conditions involve the heart muscle becoming enlarged, rigid or thick & in some rare cases the heart muscle tissue is found to be replaced with scar tissue. When these conditions deteriorate, heart becomes weak & unable to pump blood throughout the body. The normal electrical rhythm of the heart is thereby disturbed & which eventually results in irregular heartbeats known as arrhythmia or heart failure. Moreover, a weak heart can also cause other complications like problems with heart valves. Cardiomyopathy can develop because of some other disease (acquired), condition or risk factors or may be inherited through genes for disease passed on by parents. Most often, the cause of cardiomyopathy is unknown. However, it affects people of all ages, but certain age groups are more prone to developing cardiomyopathy.

Causes of Cardiomyopathy

In most of the cases, cause of cardiomyopathy is not known. However, in some people contributing factors have been identified & possible causes of cardiomyopathy generally include the following.

  • Problems with Heart Valves
  • Chronic Rapid Heart Rate
  • Damage to Heart Tissue from Heart Attacks
  • Long Term High Blood Pressure
  • Genetic Factors
  • Connective Tissue Disorders
  • Complications from Pregnancy
  • Amyloidosis (disorder causing buildup of abnormal proteins)
  • Sarcoidosis (conditions causing inflammation & lumps of cells to develop in heart & other organs)
  • Hemochromatosis (buildup of iron in heart muscle)
  • Nutritional Deficiencies (involving essential minerals & vitamins like (thiamin) vitamin B1)
  • Metabolic Disorders like Diabetes, Thyroid Disease or Obesity
  • Consuming Excessive Alcohol (over several years)
  • Use of Anabolic Steroids, Amphetamines or Cocaine
  • Use of some radiation & chemotherapy drugs for treatment of cancers
  • Certain Infections (which can injure heart muscle & trigger cardiomyopathy)

Types of Cardiomyopathy

Though there are three main types of cardiomyopathy, there are some others which are less common including the following.

  • Dilated Cardiomyopathy – This is one of the most common types of cardiomyopathies where the pumping ability of the main pumping chamber of the heart, the left ventricle deteriorates to become less forceful. This is mainly because the left ventricle gets dilated (enlarged) & therefore is unable to effectively pump out blood from the heart. Dilated cardiomyopathy is most often found to occur in middle-aged people & more likely among men, although it can affect people of all ages. However, some patients with dilated cardiomyopathy have family history while others develop this as a result of certain conditions like infections, coronary heart disease, undergoing chemotherapy, or abuse of alcohol or drugs. In many cases cause of dilated cardiomyopathy may be idiopathic (unknown) as well.
  • Hypertrophic Cardiomyopathy – This type of cardiomyopathy is caused due to abnormal thickening of the heart muscle belonging to the left ventricle, which is the main pumping chamber of the heart. Thickening of this heart muscle eventually makes it more difficult for the heart to pump the required quantity of blood. Hypertrophic cardiomyopathy is found to develop among people of all ages but tends to be more severe in case it becomes apparent during childhood. Most people affected by hypertrophic cardiomyopathy have a family history of this condition along with genetic mutations which have been linked to this heart disease.
  • Restrictive Cardiomyopathy – Heart muscle of patients affected by restrictive cardiomyopathy is found to become less elastic & rigid. As a result their heart is unable to expand fully & get filled with blood in-between heartbeats. This condition most often tends to occur among older people, although it can occur among people of all ages. However, restrictive cardiomyopathy is the least common type of cardiomyopathy & is generally found to occur for unknown reasons (idiopathic). Restrictive cardiomyopathy is also caused by diseases occurring elsewhere in the body but which also affect the heart including Hemochromatosis or iron buildup in heart muscle, Sarcoidosis disease which causes inflammation resulting in formation of lumps of cells in heart & other organs, Amyloidosis disorder which causes buildup of abnormal proteins, connective tissue disorders, or eosinophilia heart disease causing abnormal blood cells to damage heart.
  • Arrhythmogenic Right Ventricular Dysplasia – This is a rare type of cardiomyopathy in which the muscle in the right ventricle (lower right heart chamber) is found to be replaced by scar tissue. Eventually, arrhythmogenic right ventricular dysplasia leads to problems of the heart rhythm. Most often this heart condition is caused by genetic mutations.

Risk Factors for Cardiomyopathy

Cardiomyopathy involves a number of risk factors which can increase chances of developing this condition.

  • Obesity – The heart of an overweight person has to work harder than normal. This can therefore put an obese individual at higher risk of heart failure & cardiomyopathy.
  • Conditions Affecting the Heart – Having coronary artery disease, heart attacks or viral infections affecting the heart put a person at higher risk of developing cardiomyopathy.
  • High Blood Pressure – Having high blood pressure over long term puts a person at high risk for developing cardiomyopathy.
  • Family History – People having a family history of sudden cardiac arrest, heart failure & cardiomyopathy are more likely to develop this condition than people without any family history of heart problems.
  • Diabetes – People with diabetes are at higher risk of developing heart problems like heart failure & cardiomyopathy.
  • Cancer Treatments – Many cancer treatments are found to damage some healthy cells as well. Although it is necessary to treat cancer, certain radiation therapies & chemotherapy drugs are found to increase risk of developing cardiomyopathy.
  • Hemochromatosis – This is a disorder which causes the body to store excessive amounts of iron. This factor is eventually linked to one of the causes which increases risk of developing cardiomyopathy.
  • Thyroid Disorders – Both, having an underactive or overactive thyroid gland are found to increase risk of developing cardiomyopathy.
  • Diseases Affecting the Heart – Other diseases of the heart like Sarcoidosis causing lumps of cells to grow within heart & other organs of the body, Amyloidosis which causes buildup of abnormal proteins & connective tissue disorders are also found to increase risk of a person developing cardiomyopathy.
  • Alcoholism – Abusing alcohol will eventually damage a person’s heart & cardiomyopathy may result as a consequence. This risk significantly increases when a person has been consuming 7 – 8 drinks each day for more than five years.
  • Illicit Drug Abuse – This includes drugs like anabolic steroids, amphetamines & cocaine which are found to increase risk of developing cardiomyopathy.

Signs & Symptoms of Cardiomyopathy

Cardiomyopathy patients in early stages do not experience any signs & symptoms. However, signs & symptoms usually appear as the condition advances. Common signs & symptoms of cardiomyopathy include the following.

  • Exertion causes breathlessness or even while resting
  • Swelling in feet, ankles & legs
  • Fatigue
  • Coughing while lying down
  • Bloating of abdomen because of fluid buildup
  • Chest pain
  • Irregular heartbeats which can be rapid, fluttering or pounding
  • Lightheadedness, dizziness & fainting

Signs & symptoms tend to get worse when left untreated in all types of cardiomyopathy. However, worsening of symptoms may happen quickly in some people while it may take a long time in others. Nevertheless, one must see a doctor whenever any one or more signs & symptoms associated with cardiomyopathy appear, especially when they are experiencing severe difficulty in breathing along with chest pain or fainting which lasts more than a few minutes of time. Following this doctors may also advise that other family members may also be examined for cardiomyopathy as this condition is sometimes found to be hereditary.

Complications Associated with Cardiomyopathy

Complications of cardiomyopathy can lead to a number of other heart conditions including the following.

  • Heart Failure – This usually means that the heart is unable to pump enough blood which is required by the body. The weakened, stiffened and/or thickened muscle of the heart due to cardiomyopathy cannot effectively pump or may even stop flow of blood from heart. Moreover, it can also be life threatening when this condition is left untreated.
  • Heart Valve Problems – Heart valves of cardiomyopathy patients may not be able to close properly because they have an enlarged heart. Eventually, this may lead to a backward flow of blood.
  • Blood Clots – Cardiomyopathy patients are more likely to have blood clots in heart simply because the heart is unable to effectively pump blood. Moreover, these clots can enter the bloodstream when they are pumped out of heart & subsequently even block flow of blood to organs, including brain & heart. In order to overcome this problem, cardiologists usually prescribe blood thinners & anticoagulant medications like aspirin, warfarin (Jantoven, Coumadin), rivaroxaban (Xarelto), dabigatran (Pradaxa), apixaban (Eliquis) or clopidogrel (Plavix).
  • Cardiac Arrest & Sudden Death – Cardiomyopathy in some cases will lead to abnormal rhythms of the heart which are too slow to enable effective blood flow through the heart. While in some other cardiomyopathy patients heart rhythms can be too fast & may not allow proper heartbeats. In both these cases abnormal heart rhythms can result in fainting or even sudden death when heart stops beating effectively.

Diagnosing Cardiomyopathy

Doctors will diagnose cardiomyopathy based upon medical & family histories, physical examination & test results of the patient. Most often cardiologists or pediatric cardiologists who are doctors specializing in heart diseases, will diagnose & treat cardiomyopathy.

  • Medical & Family History – Cardiologists will like to know the medical history of the patient along with the signs & symptoms the patient is experiencing. They will also like to know as to anyone else in the family has ever had cardiomyopathy, heart failure or sudden cardiac arrest.
  • Physical Examination – Cardiologists will listen to the patient’s heart & lungs for sounds which may suggest cardiomyopathy with help of a stethoscope. Upon examination, they may even suggest presence of specific type of heart disease. Location, timing & loudness of heart murmurs can suggest obstructive hypertrophic cardiomyopathy, while crackling sound in lungs may suggest heart failure. Other physical signs like swelling of feet, ankles, legs, abdomen or veins within the neck region may suggest buildup of fluid which may suggest heart failure.
  • Diagnostic Tests – Cardiologists usually recommend any one or more of the tests mentioned below for diagnosing cardiomyopathy.
    • Blood Tests – Small amount of the patient’s blood is usually taken from a vein in arm with help of a needle. Although this may cause some temporary discomfort to the patient, this procedure is typically easy & quick.
    • Chest X-Rays – These are meant to take pictures of organs & structures inside the chest including heart, lungs & blood vessels. It can effectively show if the heart is enlarged or there is buildup of fluid within lungs.
    • Electrocardiogram (EKG) – This is a procedure which is meant to record the electrical activity of the heart. It will show as to how fast the heart is beating & whether the rhythm is steady or irregular. EKG test also records the strength & timing of electric signals which pass through portions of the heart & is therefore used for detecting & studying many heart problems including irregular heartbeats (arrhythmias), heart attacks & heart failure.
    • Holter & Event Monitors – These are small portable devices which are meant to record the electrical activity of the heart during normal daily activities of the patient’s routine. While Holter monitor records electrical activity for a complete 24 – 48 hour time span, event monitors are meant to record electrical activity of the heart only at certain specific times when the patient is wearing the device. Many event monitors involve pushing of button for starting the monitor whenever the patient begins to experience symptoms, while others can automatically start when they sense abnormal rhythms of the heart.
    • Echocardiography – This is a test which uses sound waves for creating a moving picture of heart in order to show its size & shape & how well it is functioning. There are many types of echo tests including stress echo which is performed as part of the stress test. Stress echo test effectively shows if the patient is having decreased blood flow through heart. Another type of echo test is Tran’s esophageal echo or TEE which provides a view of the back of heart.
    • Stress Test – Patients either exercise or are given medicine in case they are unable to exercise during stress tests. The aim of stress is to make the heart work harder & beat fast while tests are performed. Stress tests generally include echo, nuclear heart scanning & PET (Positron Emission Tomography) scanning of the heart.
  • Diagnostic Procedures – In order to diagnose cardiomyopathy, one or more procedures may be involved or a procedure may be employed as preparation for surgery if it is planned. Most common diagnostic procedures which are used for diagnosing cardiomyopathy include coronary angiography, cardiac catheterization or myocardial biopsy.
    • Cardiac Catheterization – This procedure is used for checking pressure & flow of blood within the chambers of the heart. Cardiac catheterization also allows cardiologists to collect samples of blood & take a look at the arteries of the heart with help of x-ray imaging. The procedure involves putting in a long, thin & flexible tube called catheter into a blood vessel either in the arm, neck or groin & threading it all the way to the heart. Eventually, this will permit the cardiologist inside coronary arteries for blockages.
    • Coronary Angiography – This is a procedure which is most often performed along with cardiac catheterization procedure for diagnosing cardiomyopathy. A contrast dye is injected in the coronary arteries which give a clear picture of blockages on x-rays. Following this, cardiologists can conveniently study flow of blood through heart & its blood vessels. Doctors will also inject contrast dye into heart chambers in order to examine pumping function of the heart.
    • Myocardial Biopsy – This is a procedure in which the cardiac surgeon removes a piece of heart muscle with help of cardiac catheterization procedure. Subsequently the muscle sample is studied under a microscope in a laboratory to observe changes in cells which may have occurred due to cardiomyopathy.
    • Genetic Testing – Genetic testing is usually suggested when doctors are looking for cardiomyopathy in brothers, sisters, parents & other family members. This procedure can show if the disease is running in the family & can point out chances of parents passing over genes for disease to their children. Genetic testing is also useful when doctors suspect that the patient is having cardiomyopathy but has not yet displayed any signs & symptoms. In such a scenario doctors may start early treatment if the disease is detected & improve chances of successful outcomes.

Treatment Options for Cardiomyopathy

  • Lifestyle Changes – Quite often lifestyle changes are helpful in managing conditions which are causing cardiomyopathy in the first place. However, some people may require medical advice before starting or increasing physical activities. They must therefore talk to doctors in case they are having any ongoing health issues, or have symptoms like chest pain, dizziness, shortness of breath or are on medicine. Doctors can suggest as to which type & amount of physical activity is safe for them.
    • Both, a healthy diet & physical activity are included in a healthy lifestyle. Healthy diet should include a variety of vegetables, fruits & whole grains constituting at least half of the products.
    • It is ideal to choose foods which are low in cholesterol, trans-fat & fats. Best choices include low-fat milk & milk products, beans, fish, poultry without skin & lean meats.
    • Care should be taken to choose prepared foods with little salt as too much of salt will raise risk of high blood pressure.
    • Avoiding alcohol & choosing foods & beverages with low added sugar should be preferred. For people consuming alcoholic beverages, care should be taken to do so in moderation.
    • Keep tab on daily calories requirements & aim for maintaining healthy weight. Balance the calories & burn excess with exercise & be as physically active as it is possible.

Other lifestyle changes recommended by doctors include the following.

  • Quit Smoking
  • Lose Excessive Weight
  • Avoid Illegal Drugs & Alcohol
  • Get Enough Sleep & Rest
  • Reduce Stress
  • Treat Underlying Conditions like Diabetes & High Blood Pressure
  • Medical Treatments for Conditions Associated with Cardiomyopathy

    There are several medicines which are used in the treatment of cardiomyopathy including the ones mentioned below which doctors usually prescribe.

    • Calcium Channel Blockers, Beta Blockers, Angiotensin II Receptor Blockers & ACE Inhibitors are usually given for lowering blood pressure.
    • Digoxin, Calcium Channel Blockers, & Beta Blockers are usually given for slowing down heart rate.
    • Antiarrhythmics are medicines which prevent arrhythmias & keep the heart beating in normal rhythm.
    • Electrolytes are helpful in maintaining acid-base & fluid levels in the body. They also help nerve tissues & muscles work properly. Abnormal levels of electrolyte cause high blood pressure, heart failure, dehydration & other disorder. Aldosterone blockers are good examples which help in balancing electrolytes.
    • Diuretics are also known as ‘water pills’. This medicine is very helpful in removing excessive fluid & sodium from body.
    • Preventing formation of blood clots is essential for cardiomyopathy patients. Blood thinners or anticoagulants are good medicines which help in preventing formation of blood clots. Moreover, blood thinners are commonly recommended for dilated cardiomyopathy patients.
    • Reducing inflammation is also important & for which corticosteroids are usually given to cardiomyopathy patients.
  • Surgical Treatments for Cardiomyopathy

    There are many types of surgical intervention which are used for treating patients with cardiomyopathy. Some of these surgical procedures are listed below.

  • Septal Myectomy

    This is an open-heart surgical procedure which is used for patients having severe symptoms of obstructive hypertrophic cardiomyopathy. However, this is mostly used for younger patients & for them whose medicines are not working well. Cardiac surgeons would remove a portion of the thickened septum bulging into the left ventricle during this procedure. Septal myectomy is meant to improve flow of blood through heart & out into the body. However, the tissue which is removed will not grow back. In some cases cardiac surgeons will also repair or replace mitral valve at the same time if required during this procedure. Most often, septal myectomy is successful & will allow patients to get back into normal life without any symptoms.

  • Surgically Implanted Devices

    During surgical interventions cardiologists place many types of devices in heart which can help in improving function. Pacemaker is a small device which is placed under skin of chest or abdomen & which effectively helps in controlling arrhythmias by use of electrical pulses prompting heart to beat at normal rates. Cardiac Resynchronization Therapy or CRT is another device which coordinates contractions between the right & left ventricles of the heart. Left Ventricular Assist Device or LVAD is used as a short-term or long-term treatment which helps heart pump sufficient quantities of blood to the body. Implantable Cardioverter Defibrillator or ICD is another such heart device that is helpful in controlling life threatening arrhythmias leading to sudden cardiac arrest. ICD device which is implanted in chest or abdomen & connected to heart is able to sense dangerous changes to heart rhythm & will then send electric shock to heart in order to restore normal heartbeat.

  • Heart Transplant

    This organ transplantation surgery effectively replaces a patient’s diseased heart with a healthy heart obtained from a deceased donor. However, heart transplantation is the last resort of treatment for people having end-stage heart failure. This is a heart condition where the disease has become so severe that all treatments except for heart transplantation have failed to yield results.

  • Nonsurgical Procedures

    There also is a nonsurgical procedure known as alcohol septal ablation which is used for treating cardiomyopathy. Cardiac surgeons will inject ethanol during this procedure through a tube into the small artery which is supplying blood to thickened area of heart muscle. This ethanol is meant to destroy cells & thereby shrink the thickened tissue to normal size. Eventually, this allows free flow of blood through the ventricle & which eventually improves cardiomyopathy symptoms of the patient.

Preventive Measures for Cardiomyopathy

Although inherited types of cardiomyopathy cannot be prevented, there are certain steps a person can take in order to lower risk of diseases or conditions which lead to cardiomyopathy. Cardiomyopathy most often is due to an underlying disease or condition like high blood pressure, coronary heart disease & heart attacks. Early treatment of these conditions will therefore help in preventing complications associated with cardiomyopathy. In order to control diabetes, high blood cholesterol & high blood pressure, patients must undergo regular checkups & follow the doctor’s advice regarding changes in lifestyle. They should also take their medicines on time as prescribed by the doctor. However, sudden cardiac arrest is a complication of cardiomyopathy which can be effectively prevented in high risk people by treating them with an implantable cardioverter defibrillator device.

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