What is Cardiomyopathy?

Cardiomyopathy refers to diseases of the heart muscle. In these diseases, the heart muscle becomes enlarged, thick or rigid and, at time, scar tissue can replace muscle tissue. As cardiomyopathy progresses, the heart becomes weaker and is less able to pump blood throughout the body. This can lead to arrhythmias, heart valve problems or heart failure.

Cardiomyopathy types include:

• Dilated cardiomyopathy: The most common form of cardiomyopathy, also known as an enlarged heart, occurs when heart muscles are too weak to pump blood efficiently. The muscle stretches, expanding the hearts chambers.
• Hypertrophic cardiomyopathy: This is often genetic and occurs when heart walls thicken and prevent blood flow.
• Restrictive cardiomyopathy: This least common form occurs when ventricles stiffen and can’t relax enough to fill with blood. Scarring can also lead to this type.
• Takotsubo (stress) cardiomyopathy: Also known as broken-heart syndrome, this is a weakening of the left ventricle, usually as a result of severe emotional or physical stress.

A person can be born with cardiomyopathy or it can develop over time. Cardiomyopathy symptoms and treatments vary depending on the type.

Baptist Health is known for advanced, superior care for patients with heart disease and the diagnosis, management and treatment of cardiomyopathy. You will appreciate timely appointments and respectful attention to your concerns, all in a positive and friendly atmosphere. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.

Signs and Symptoms

Some people with mild cardiomyopathy have no symptoms and do not require treatment. For many, cardiomyopathy symptoms don’t appear until later stages of the condition and may include:

• Bloating of the abdomen due to fluid buildup
• Breathlessness with exertion (or sometimes at rest)
• Chest pain
• Cough while lying down
• Dizziness, lightheadedness and fainting
• Irregular heartbeats (rapid, pounding or fluttering)
• Loss of appetite
• Swelling of the legs, ankles and feet

Diagnosis

To diagnose cardiomyopathy and identify the type, we ask questions about your medical history and do a physical exam. We then use advanced diagnostic procedures and technology to effectively diagnose, inform treatment and carefully monitor the condition. Common diagnostic procedures can include:

Blood test: Blood tests check the levels of certain fats, cholesterol, sugar and protein in the blood that could indicate heart conditions.

Cardiac catheterization: A long, thin flexible tube is threaded through a blood vessel in the arm or groin and to the heart. Contrast material is injected through the tube and a type of X-ray video is taken to show how the heart functions and to look for heart blockages.

Computed tomographic angiography (CT):This non-invasive test can show the arteries in the abdomen, pelvis and legs. This test is particularly useful in patients with pacemakers or stents.

Chest X-ray:A common imaging test of the lungs, heart and aorta.

Coronary angiography: This procedure often is done with cardiac catheterization. During the procedure, dye that can be seen on an X-ray is injected into the heart chambers or coronary arteries. The dye lets a physician study blood flow through the heart and blood vessels to detect any blockages.

Echocardiogram: This ultrasound exam uses soundwaves to take moving pictures of the heart’s chambers and valves.

Electrocardiogram (EKG): This test measures the electrical activity of the heart and can help determine if parts of the heart are enlarged, overworked or damaged. The heart’s electrical currents are detected by 12 to 15 electrodes that are attached to the arms, legs and chest via sticky tape.

Electrophysiology study:This test records the heart’s electrical activities and pathways. It can help find what’s causing heart rhythm problems and identify the best treatment.

Genetic testing or screening:Some types of cardiomyopathy run in families. A genetic test can identify the condition in other family members, determine the chances of a parent passing the gene to a child and identify hereditary cardiomyopathy before symptoms appear.

Magnetic resonance imaging (MRI):A large magnet, radio waves and a computer are used to produce pictures of the heart and blood vessels.

Myocardial biopsy: For this procedure, the physician removes a piece of heart muscle, often during cardiac catheterization. The heart muscle is studied under a microscope to see whether changes in cells have occurred. These changes may suggest cardiomyopathy.

Stress testing: This test is conducted during exercise. If a person can't exercise, medicine is given to increase heart rate. Used along with an EKG, the test can show changes to the heart’s rate, rhythm or electrical activity as well as blood pressure. Exercise makes the heart work hard and beat fast while heart tests are administered.

Causes

The following can lead to cardiomyopathy:

• Diabetes
• Heavy alcohol use
• High blood pressure
• Nutritional deficiencies (such as thiamin, B-1)
• Obesity
• Use of cocaine, amphetamines or anabolic steroids

Risk Factors

Risk factors that could contribute to cardiomyopathy include:

Amyloidosis: This disorder causes a buildup of abnormal proteins.

Chemotherapy and radiation: Certain drugs and radiation treatments for cancer can contribute to cardiomyopathy development.

Chronic rapid heart rate: Stress from certain arrhythmias can cause cardiomyopathy.

Connective tissue disorders: Conditions like scleroderma and Marfan syndrome can lead to cardiomyopathy.

Genetic conditions: Certain types of cardiomyopathy run in families.

Heart tissue damage: The heart muscle can be damaged by a previous heart attack or certain infections, increasing the risk of cardiomyopathy.

Heart valve problems: Congenital or acquired heart valve problems increase the risk of developing cardiomyopathy.

Iron buildup: This buildup in the heart muscle is caused by an inherited disorder known as hemochromatosis.

Metabolic conditions: Problems with the thyroid, pituitary gland or pancreas can lead to certain types of cardiomyopathy.

Pregnancy complications: Peripartum cardiomyopathy is an uncommon form of heart failure that happens during the last month of pregnancy or up to five months after giving birth. It causes the heart chambers to enlarge and the muscle to weaken.

Sarcoidosis: This condition causes inflammatory lumps of cells to grow in the heart and other organs.

Prevention

While you cannot prevent inherited types of cardiomyopathy, you can take steps to lower your risks for diseases or conditions that can lead to or complicate cardiomyopathy:

Balance your blood sugar: If you have diabetes, watch what you eat and check your blood glucose regularly. Talk to your physician about medications that control blood sugar spikes.

Control high blood pressure and cholesterol: Stop smoking, eat a healthy diet, exercise and take medications as prescribed.

Get regular checkups: And, if you experience new or changing symptoms or side effects from medications, see your physician.

Reduce your alcohol intake and don’t use drugs: In some cases, you may need to stop drinking alcohol entirely or keep intake very low.

Take your medications as prescribed: If you’ve been prescribed a medication for cardiomyopathy or a causative condition, be sure to take it as prescribed.

Prognosis

Prognosis varies depending on the type and causes of cardiomyopathy.

Arrhythmogenic right ventricular dysplasia (ARVD): The majority of patients who stop exercising early on in the course of their ARVD do well. Arrhythmias can be controlled with medication and implantable cardioverter defibrillators (ICDs).

Dilated cardiomyopathy: This type is associated with a survival rate of less than 50 percent at 10 years. However, with better supportive care, improved 5- and 10-year survival rates have been reported. Peripartum cardiomyopathy, a type of dilated cardiomyopathy, may be reversible in up to 50 percent of patients.

Hypertrophic cardiomyopathy (HCM): Most patients with HCM have absent or mild symptoms and lead normal, active lives.Some patients experience more severe, progressive symptoms that require medications and/or treatment procedures. A minority of patients have an increased risk of sudden death, often at a young age, and often during competitive sports.

Restrictive cardiomyopathy: People with this condition often develop heart failure that gets worse and may develop leaky heart valves. Prognosis is poor without heart transplant, in many cases.

Takotsubo (stress) cardiomyopathy: Though initial symptoms can be severe, most patients survive with few complications and an excellent long-term prognosis.

Treatment and Recovery

Cardiomyopathy treatment depends on the type of condition, the severity of symptoms and complications, and the patient’s overall health.

Medications

Your physician may prescribe medications to control your heart rhythm.

Lifestyle Changes

Changes to diet and exercise can help restrictive cardiomyopathy. Your physician may tell you to restrict your intake of sodium and gradually begin a low-impact, low-intensity exercise routine.

Surgery

There are several types of procedures that may be used to treat cardiomyopathy, including:

• Implantable cardioverter-defibrillator (ICD): An ICD is inserted under the skin, just below the collarbone, with thin wires leading to the heart. It monitors heart rhythm and delivers electric shocks, when needed, to control abnormal heart rhythms. If you are experiencing, or at risk for, dangerous arrhythmias, your physician may recommend this device.
• Radiofrequency ablation: In this procedure, a physician guides long, flexible tubes (catheters) through blood vessels to the heart. Electrodes at the catheter tips transmit radiofrequency energy to damage (ablate) a small spot of heart tissue that is causing an abnormal heart rhythm. If other treatments aren’t controlling your abnormal heart rhythms, your physician may recommend this procedure.
• Septal ablation: During this procedure, a small portion of the thickened heart muscle is destroyed by injecting alcohol through a long, thin catheter into the artery supplying blood to that area.
• Septal myectomy: In this procedure, a surgeon removes part of the thickened heart muscle wall (septum) that separates the two ventricles. Removing this improves blood flow through the heart and reduces mitral valve regurgitation.
• Ventricular Assist Devices (VADs): A ventricular assist device (VAD) is an implantable mechanical pump designed to support heart function and blood flow in people who have weakened hearts. You may have a VAD implanted while you wait for a heart transplant or for your heart to become strong enough to pump blood on its own. Your physician may also recommend VAD as a long-term treatment if you have heart failure and you’re not a good candidate for a heart transplant. VAD implantation requires open-heart surgery.
• Heart transplant: A heart transplant is the replacement of a person’s diseased heart with a donor’s healthy heart. A transplant is considered when heart failure is severe and not responding to other therapy, but a person’s health is otherwise good. In order to get a heart transplant, you must be screened and placed on a transplant list. Unfortunately, not enough hearts are available for transplant. Thousands of people wait months for transplants and more than 25 percent do not live long enough to get one. Transplant surgery will take place as soon as possible after a donor heart becomes available. During surgery, you would be placed on a heart-lung machine while the new heart is sewn into place and blood vessels are connected. This procedure carries risks of infection and rejection, as well as coronary artery disease.

Complications

Cardiomyopathy can lead to other heart conditions, including:

Blood clots: If the heart cannot pump effectively, blood clots may form in the heart and enter the bloodstream where they can block blood flow to other organs.

Cardiac arrest and sudden death: Cardiomyopathy can lead to arrhythmias that could result in fainting or even cardiac arrest if the heart stops beating effectively.

Heart failure: When the heart is unable to pump oxygen-rich blood to the rest of the body efficiently, symptoms affect various body systems.

Valve problems: If the heart is enlarged, valves may not close properly, allowing a backward flow of blood.