Ischemic Cardiomyopathy

What is ischemic cardiomyopathy?

Ischemic cardiomyopathy describes heart muscle that can’t pump well because of damage from a lack of blood supply to the muscle. Coronary artery disease and heart attacks cause this lack of blood supply (ischemia).

This lack of blood weakens and enlarges the left ventricle in people with ischemic cardiomyopathy. Because your left ventricle is your heart’s main pumping chamber, a weak left ventricle decreases your heart’s ability to pump blood.

Ischemic cardiomyopathy is the most common type of dilated cardiomyopathy and the world’s top cause of systolic heart failure. It causes 60% of cases.

What are the symptoms of ischemic cardiomyopathy?

Ischemic cardiomyopathy symptoms may include:

• Shortness of breath.
• Swelling in your legs and feet (edema).
• Fatigue that makes you unable to exercise or carry out everyday activities.
• Angina (a less common symptom).
• Weight gain, cough and congestion related to fluid retention.
• Palpitations or fluttering in your chest because of abnormal heart rhythms (arrhythmia).
• Dizziness or lightheadedness.
• Fainting.

Some people may not have symptoms of ischemic cardiomyopathy.

What causes ischemic cardiomyopathy?

Causes of ischemic cardiomyopathy are conditions that damage your heart muscle due to low blood flow, such as:

• Coronary artery disease. (This is the most common cause.)
• Heart attack.
• Coronary vasculitis.
• Coronary artery dissection.
• Coronary microvascular disease.
• Fibromuscular dysplasia.
• Prinzmetal angina.

What are the risk factors for ischemic cardiomyopathy?

Major risk factors of heart disease can put you at an increased risk for cardiovascular (heart and blood vessel) disease and ischemic cardiomyopathy. These risk factors include:

• Having a family history of heart disease.
• Having high blood pressure.
• Using tobacco products.
• Having diabetes.
• Having high cholesterol.
• Having a body mass index (BMI) greater than 30.
• Having a history of a heart attack.
• Not being physically active.

What are the complications of ischemic cardiomyopathy?

Complications of ischemic cardiomyopathy include:

• Abnormal heart rhythm.
• Congestive heart failure.
• Pulmonary edema.
• Mitral valve regurgitation.
• Blood clots.
• Cardiac arrest.
• Sudden cardiac death.

How is ischemic cardiomyopathy diagnosed?

A healthcare provider will diagnose ischemic cardiomyopathy based on:

• Your medical history.
• Your symptoms.
• Your family’s medical history.
• A physical exam.
• Tests.

What tests will be done to diagnose ischemic cardiomyopathy?

Specific tests to diagnose ischemic cardiomyopathy may include:

• Blood tests.
• Electrocardiogram (EKG).
• Chest X-ray.
• Transthoracic echocardiogram (TTE).
• Exercise stress test.
• Cardiac catheterization.
• CT scan.
• MRI scan.
• Nuclear medicine imaging.

Occasionally, a provider may perform a myocardial biopsy to determine the cause of cardiomyopathy.

How is ischemic cardiomyopathy treated?

For ischemic cardiomyopathy treatment, healthcare providers focus on:

• Treating coronary artery disease.
• Improving cardiac function.
• Reducing heart failure symptoms.

Treatments to decrease symptoms and improve quality of life may include:

• Medications.
• Lifestyle changes.
• Implantable devices.
• Interventional procedures and surgeries.

Medications

Medications you take may include:

• Beta-blockers.
• ACE inhibitors.
• ARBs.
• ARNI.
• Diuretics.
• Aldosterone antagonists.
• Antiarrhythmics.
• Anticoagulants (blood thinners).
• Statins.

Medications can help:

• Improve cardiac function.
• Treat symptoms of heart failure.
• Prevent complications.
• Prevent coronary artery disease progression.
• Prevent heart attacks.

Your provider will discuss what medications are best for you.

Lifestyle changes

You can make changes in your daily routine that’ll improve your health. Changes include:

• Limiting salt intake to 2,000 to 3,000 milligrams (mg) per day.
• Exercising.
• Avoiding tobacco products.
• Following theMediterranean Diet.

Implantable devices

Some people need a device that can help their hearts work better. Types of devices include:

• Cardiac resynchronization therapy (CRT, or biventricular pacing).
• Implantable cardioverter defibrillators (ICD).

You may receive both devices combined in a single unit. This is a CRT-D.

Interventional procedures and surgeries

Interventional procedures and surgeries include:

• Angioplasty.
• Stents.
• Coronary artery bypass surgery.
• Surgical remodeling or reconstruction of the left ventricle.
• Left ventricular volume reduction surgery.
• Left ventricular assist devices.
• Heart transplant.
• Other heart failure surgical options.

Complications/side effects of the treatment

Side effects and complications vary by treatment:

Medications

• Dizziness.
• Upset stomach.
• Fatigue.
• Dry cough.
• Headache.
• Low blood pressure.
• Hair loss.
• Bleeding.

Implantable devices

• Bleeding.
• Infection.
• Device malfunction.
• Collapsed lung.
• Cardiac tamponade.

Procedures and surgeries

• Chest pain.
• Bleeding.
• Infection.
• Heart attack.
• Blood clots.
• Irregular heart rhythms.
• Stroke.
• Rejection of a transplanted heart.

How long does it take to recover from this treatment?

It can take a few weeks for a medication to reach its full effectiveness. Recovery times for other treatments can range from a day or so to several weeks or even months.

Can ischemic cardiomyopathy be prevented?

You can prevent ischemic cardiomyopathy by preventing coronary artery disease. This is the most common cause of ischemic cardiomyopathy.

How can I lower my risk?

You can lower your risk of coronary artery disease and the cardiomyopathy it can cause by:

• Avoiding tobacco products.
• Exercising for 30 minutes five times a week.
• Getting the sleep you need.
• Reaching a weight that’s healthy for you.
• Managing your daily stress.
• Managing conditions such as diabetes, high cholesterol and high blood pressure.
• Eating healthy foods, such as vegetables and fruits.
• Limiting the amount of alcohol you drink.

What can I expect if I have ischemic cardiomyopathy?

Depending on your situation, your heart muscle damage could be mild or severe.

Medications help your heart work better and ease your symptoms. But if these aren’t enough, your provider will recommend procedures or devices.

Can ischemic cardiomyopathy be reversed?

You may be able to reverse ischemic cardiomyopathy if you only have a lack of blood flow for a short time. But when your heart muscle doesn’t get enough blood and oxygen for a longer time, you can’t reverse the damage. This can happen when you have a heart attack.

Outlook for ischemic cardiomyopathy

The extent of damage to your heart muscle is a big factor in your prognosis. However, treatment can improve your situation. A provider will consider several things when talking about your outlook, such as:

• How much blood your left ventricle can pump (ejection fraction).
• How severe your coronary artery disease is.
• Whether you’ve had a heart attack.

How do I take care of myself?

You have the power to make changes in your everyday life that improve your health. You can:

• Work toward a weight that’s healthy for you.
• Limit the amount of alcohol you drink.
• Get enough sleep every night.
• Exercise regularly.
• Eat foods that are good for your heart, such as foods that have little saturated fat or salt.
• Avoid tobacco products.
• Manage your stress level.

When should I see my healthcare provider?

You’ll need to see your healthcare provider a few times a year so they can monitor your condition. Regular appointments help them see:

• How well your medicines are working.
• How well your device is working, if you have one.
• How well you’re recovering from a procedure or operation.

Between visits, contact your provider if:

• Your symptoms get worse.
• You get symptoms you didn’t have before.
• Your device isn’t working right.
• You’re having side effects from your medication.

When should I go to the ER?

Seek emergency care if you have:

• Shortness of breath.
• Chest pain.
• Fainting.

What questions should I ask my doctor?

Questions to ask your healthcare provider may include:

• How much heart muscle damage do I have?
• What’s the best treatment for me?
• Is there a support group that could help me?

A note from Cleveland Clinic

A diagnosis of ischemic cardiomyopathy can make you uneasy. But your healthcare provider can help you deal with it by suggesting the best treatment for you. And there are always things you can do to help yourself. Start by keeping your appointments and taking the medicines your provider prescribes for you. Ask your provider about anything you don’t understand about your condition.