Cardiomyopathy

Cardiomyopathy is a disease of the heart muscles. It is a condition in which the heart muscle becomes thick, rigid or enlarged or may get replaced with a scar tissue (but is rare). Worsening of cardiomyopathy can weaken the heart, reducing its ability to pump blood to the body parts. Gradually it can lead to heart failure.

In some people with cardiomyopathy, the symptoms are not evident in the early stages but become visible only after the heart gets compromised. The following symptoms may occur in the patients with cardiomyopathy:

  • Difficulty in breathing or shortness of breath
  • Fatigue (extreme tiredness)
  • Swelling of legs, feet, ankles and abdomen and rarely in the veins of your neck
  • Dizziness or lightheadedness
  • Chest pain
  • Heart murmurs (extra sounds during heartbeat)
  • Arrhythmias (irregular heart beat).
  • Cough while lying down

Consult your doctor if you have one or more of the above symptoms for further evaluation.

There are various types of cardiomyopathy as detailed below:

  1. Dilated Cardiomyopathy: This is the most common type and occurs due to the weak heart muscles. They stretch and become thinner causing the chambers to expand.
  2. Hypertrophic Cardiomyopathy: It is less common and occurs due to the thickening of heart muscles which obstructs blood flow through the heart.
  3. Arrhythmogenic Right Ventricular Dysplasia (ARVD): This is very rare but can even lead to death. It involves abnormal heart rhythms due to the replacement of the heart muscle with fat and fibrous tissue in the right ventricle.
  4. Restrictive Cardiomyopathy: It occurs due to the rigidity of the lower chamber heart muscles which cannot fill enough blood.
  5. Takotsubo cardiomyopathy: It is a temporary condition in which your heart muscle suddenly becomes “stunned”.
  6. Ischemic cardiomyopathy: in this condition the left ventricle becomes enlarged and dilated, resulting in weakening of heart muscle.
  7. Paripartum cardiomyopathy: also called as postpartum cardiomyopathy that occurs during lats month of pregnancy or about five months after delivery.

Each of the four types of cardiomyopathy has different causes such as:

  • Heart tissue damage associated with heart attack
  • Defects in the heart valves
  • Rapid heartbeat present for a prolonged period
  • Deficiency of the vitamins such as vitamin B1
  • Buildup of abnormal proteins (for example, in amyloidosis disorder)
  • Accumulation of iron in the heart
  • Connective tissue disorders

The major risk factors for all the types of cardiomyopathy are:

  • Long-term high blood pressure
  • Long-term consumption of alcohol
  • Metabolic diseases such as diabetes and obesity
  • Family history of cardiomyopathy
  • Medical conditions such as coronary artery disease, heart attack, etc.

It is important to know your risk factors for early diagnosis because not all the persons with cardiomyopathy have the associated symptoms.

If cardiomyopathy is left untreated, it can lead to the below complications.

Heart failure: It is a life-threatening condition in which the heart cannot pump adequate amounts of blood to the organs of the body.

Cardiac arrest: Cardiomyopathy involves abnormal heart rhythms (either too fast or too slow) which can lead to fainting or sudden death if the heart stops functioning effectively.

Valve problems: In the case of dilated cardiomyopathy, the valves cannot close properly and can lead to a backward flow of the blood.

Blood clots: Due to the inefficiency of pumping blood properly, blood clots form in the heart. If these clots travel to the blood vessels they can lead to stroke (in the brain) and pulmonary embolism (in the lungs).

Your doctor diagnoses cardiomyopathy based on your symptoms, family history, and medical history. Upon getting clues of cardiomyopathy, a physical examination is performed. This involves observing your heart beat and sounds with a stethoscope. Final confirmation is done based on the below diagnostic tests:

Test typePurpose of the test
Blood test
  1. To check the levels of the protein B-type natriuretic peptide (BNP), which is produced by the heart.
  2. High levels indicate a stressed heart.
Chest X-ray
  1. Gives the image of the heart.
  2. An enlarged heart is an indication of cardiomyopathy.
Echocardiogram
  1. Gives images of the heart using sound waves.
  2. Helps the physician to understand size and functioning of the heart.
Electrocardiogram Produces electrical impulses to detect any abnormalities in the heart rhythm.
Treadmill stress test
  1. To measure your heart rate, blood pressure, and breathing while walking.
  2. This test helps to determine your exercise capacity.
Cardiac catheterization To measure the pressure in your heart and to see if any blockages are present in the blood vessels.
MRI scan Used in addition to echocardiography to get images when echocardiogram is not helpful for diagnosis.

Treatment cannot reverse the condition. The main goal of the treatment is to alleviate your symptoms and prevent the condition from becoming worse. Treatment is based on the extent of damage to the heart.

Medications: Prescribed to treat high blood pressure, maintain normal heart rate, prevent fluid and water retention, prevent clots and reduce inflammation

Surgery: To implant artificial pacemakers and defibrillators

Heart transplantation: It is the last resort and involves replacing the diseased heart with a healthy heart.

Certain lifestyle changes can help in better management of your condition. They are:

  • Smoking cessation and avoiding alcohol
  • Losing your extra pounds
  • Eating more of fruits and vegetables
  • Reducing salt in diet (1500 milligrams per day)
  • Managing stress
  • Exercising regularly