Cardiomyopathy

What is cardiomyopathy?

Cardiomyopathy is a disease of the heart muscle that makes it harder for the heart to pump blood efficiently. Over time, this can lead to symptoms like fatigue and shortness of breath, and, if untreated, can progress to heart failure. Cardiomyopathy can develop after damage to the heart, such as from a heart attack, or it can be inherited.

There are several types, grouped by how they affect the heart muscle:

• Dilated cardiomyopathy: The heart's main pumping chamber (the left ventricle) becomes enlarged and weak, making it harder to pump enough blood.
• Hypertrophic cardiomyopathy: The heart muscle becomes abnormally thick, which can make it harder to pump blood and can sometimes block blood flow out of the heart.
• Restrictive cardiomyopathy: The heart muscle becomes stiff, preventing the heart’s chambers from filling properly between heartbeats.
• Arrhythmogenic right ventricular cardiomyopathy (ARVC): Muscle tissue in the right ventricle is gradually replaced by fatty and fibrous tissue, which can lead to irregular heartbeats.
• Unclassified cardiomyopathy: A category for cases that don’t fit clearly into the types above.

What are the symptoms of cardiomyopathy?

In the early stages, cardiomyopathy may not cause noticeable symptoms. As the condition progresses, symptoms can develop and may include:

• Shortness of breath, especially with exertion or when lying down
• Swelling in the legs, ankles and feet
• Fatigue
• Abdominal bloating
• Chest pain or pressure
• Dizziness, lightheadedness or fainting
• Heart palpitations, fluttering in the chest or rapid heartbeats

If you experience any of these symptoms, it is important to consult a healthcare provider.

How is cardiomyopathy diagnosed?

To diagnose cardiomyopathy, a healthcare provider will conduct a physical exam and review your medical history. They may also recommend several tests, including:

• Echocardiogram: Uses sound waves to create images of the heart's structure and function.
• Electrocardiogram (EKG/ECG): Records the electrical activity of the heart to detect abnormal heart rhythms.
• Chest X-ray: Can show the size and shape of the heart and check for fluid in the lungs.
• Cardiac magnetic resonance imaging (MRI): Provides detailed images of the heart muscle.
• Cardiac computed tomography (CT) scan: Offers detailed cross-sectional images of the heart.
• Blood tests: To check for underlying conditions that may be causing or contributing to cardiomyopathy.
• Genetic testing: To identify inherited forms of cardiomyopathy.
• Heart biopsy: In some cases, a small sample of heart muscle may be taken for examination.

How is cardiomyopathy treated?

Treatment depends on the specific type, its severity and your overall health. The goals of treatment are to manage symptoms, prevent worsening of the condition and reduce the risk of complications.

• Medications:
  
  • Beta-blockers and ACE inhibitors: To lower blood pressure, slow heart rate and help the heart pump more effectively.
  • Diuretics: To reduce fluid retention and swelling.
  • Blood thinners: To reduce the risk of blood clots.
  • Anti-arrhythmic drugs: To help control abnormal heart rhythms.
    
• Lifestyle changes: These may include a low-sodium diet, regular physical activity as advised by your doctor, limiting alcohol, avoiding tobacco and managing stress.
  
• Implantable devices:
  
  • Pacemaker:  A small device that regulates slow heartbeats.
  • Implantable cardioverter-defibrillator (ICD): Monitors heart rhythm and can deliver a corrective signal if it detects a dangerously fast or irregular heartbeat.
  • Cardiac resynchronization therapy (CRT) device: Helps the heart’s left and right chambers beat together in a more coordinated way, for hearts where the two sides have fallen out of sync.
    
• Surgery:
  
  • Septal myectomy: For hypertrophic cardiomyopathy, a procedure that removes a small amount of thickened heart muscle to ease blood flow.
  • Ventricular assist devices (VADs): Mechanical pumps that help a weakened heart pump blood.
  • Heart transplant: For severe cases where other treatments are not effective, a diseased heart is replaced with a healthy donor heart.

Regular monitoring and follow-up are important for managing cardiomyopathy. Your healthcare team will work with you to develop a personalized treatment plan. 

How can you care for yourself after a cardiomyopathy diagnosis?

Following a cardiomyopathy diagnosis, self-care involves several key areas: staying on top of medical care, making lifestyle adjustments and monitoring your health day to day.

Medical care:

• Medication management: Take all prescribed medications as directed, and understand the purpose and possible side effects of each one.
• Regular check-ups: Attend all scheduled appointments with your cardiologist and other healthcare providers so your treatment plan can be adjusted as needed.
• Diagnostic tests: Complete recommended tests, such as echocardiograms or blood work, to track your heart function over time.

Lifestyle adjustments:

• Dietary modifications: A heart-healthy diet is often recommended, typically lower in sodium and saturated/trans fats, and higher in fruits, vegetables and whole grains. A registered dietitian can offer personalized guidance.
• Fluid management: Depending on your condition, your doctor may ask you to monitor how much fluid you drink to help prevent fluid buildup.
• Physical activity: Moderate exercise approved by your doctor can often be beneficial, even if strenuous activity is restricted. Cardiac rehabilitation programs offer structured, supervised exercise plans.
• Weight management: If you are overweight, reaching a healthier weight can reduce the strain on your heart.
• Smoking cessation: Quitting smoking is important for heart health, and support resources are available if you need help.
• Alcohol consumption: Your doctor may advise limiting or avoiding alcohol, as it can affect heart function.
• Stress management: Techniques such as mindfulness, meditation or gentle yoga may help manage stress, which can impact heart health.

Monitoring your health:

• Symptom awareness: Watch for any changes in your symptoms, such as increased shortness of breath, swelling or fatigue.
• Daily weigh-ins: Your doctor may recommend weighing yourself daily  to catch fluid retention early.
• Blood pressure monitoring: Regular home blood pressure monitoring may be advised.

Open communication with your healthcare team about any concerns or changes in your condition is important for effective self-care.

Cardiomyopathy: When to call

Call 911 if you experience sudden chest pain, severe shortness of breath, sudden weakness or numbness, or loss of consciousness.

Contact your doctor if you experience:

• Increased shortness of breath, especially at rest or during light activity.
• Sudden weight gain of more than 2-3 pounds in a day, or 5 pounds in a week, which could indicate fluid retention.
• Increased swelling in your legs, ankles or abdomen.
• Increased fatigue or weakness.
• Dizziness or lightheadedness that is more frequent or severe.
• Palpitations or a sensation of a racing, pounding or irregular heartbeat.
• Any new or worsening symptoms.