Cardiomyopathy

Causes

The exact cause is often not known. Some causes may be:

Dilated

The cause of the initial damage is often not found, but may include:

• Coronary artery disease (CAD) with decreased blood flow to the heart
• Infections, often viral
• Chronic exposure to toxins, including alcohol and some chemotherapy drugs
• A rare problem of pregnancy or childbirth—probably related to the immune system
• Rarely, other illnesses such as rheumatoid arthritis, diabetes, or thyroid disease

Hypertrophic

Causes may be:

• Inherited—sometimes present at birth but often developing in teens
• Aging, associated with high blood pressure

Restrictive

Causes are often related to another health issue such as:

• Amyloidosis—protein fibers collect in the heart
• Sarcoidosis—small swelling masses (granulomas) form in many organs
• Hemochromatosis—too much iron is in the body

Risk Factors

Things that raise the chance of getting cardiomyopathy are:

• Family members with cardiomyopathy
• Alcohol use disorder
• Obesity
• Diabetes
• High blood pressure
• CAD
• Certain drugs

Symptoms

Symptoms vary depending on the type of cardiomyopathy and its severity.

Cardiomyopathy leads to heart failure and these symptoms:

• Fatigue
• Weakness
• Shortness of breath that is often worse when lying down or with activity
• Cough
• Swelling in the feet or legs
• Chest pain
• Irregular heart rhythm

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done. A stethoscope will be used to listen to the heart. Cardiomyopathies often cause heart murmurs and other odd sounds.

Pictures of the chest may be taken. This can be done with:

• Chest x-ray
• Echocardiogram

Tests may be done to see how well the heart is working. These can be done with:

• Electrocardiogram (ECG)
• Cardiac catheterization

Other tests may be done such as:

• Blood tests
• A heart biopsy

Treatment

The goals of treatment are to ease symptoms and reduce more damage to the heart.

Heart failure may be due to blockages in the arteries. Treatments to ease these blockages include:

• Angioplasty
• Placing a stent
• Coronary artery bypass surgery

Lifestyle Changes

Lifestyle changes that can ease stress on the heart include:

• Avoiding alcohol
• Reaching or maintaining a healthy weight
• Eating a heart healthy diet

Medications

Medicines that may be given include:

• Diuretics—to remove extra fluid
• Angiotensin-converting enzyme (ACE) inhibitors—to relax blood vessels, lower blood pressure, and ease the heart's workload
• Angiotensin receptor blockers—like ACE inhibitors
• Hydralazine and isosorbide dinitrate—may be used with ACE inhibitors
• Digitalis—to slow and regulate heart rate and slightly increase how hard it squeezes
• Beta-blockers—to slow the heart and limit future damage
• Spironolactone—to help people with dilated cardiomyopathy and severe symptoms

Surgery

Surgical options are:

• A pacemaker may be implanted to help heart rate and pattern.
• For people with hypertrophic disease, part of the thickened wall that separates the heart's chambers may be removed. Surgery may be needed to replace a heart valve. Another option is alcohol septal ablation. This procedure eases symptoms and improves how the heart functions.
• For those with severe, irregular heart rhythms, a cardioverter defibrillator may need to be implanted.
• A heart transplant may be possible for some people who do not respond to other treatments. The wait for a new heart can be long. People waiting may get a ventricular assist device. This is a mechanical pump that takes over some or most of the heart's pumping function.

Prevention

Some types of cardiomyopathy cannot be prevented. The risk of other types may be lowered by managing chronic health problems.