Cardiomyopathy

Cardiomyopathy is a disease that affects your myocardium (heart muscle). It can make your heart stiffen, enlarge or thicken and can cause scar tissue. As a result, your heart can’t pump blood well to the rest of your body.

With time, this condition can weaken your heart and lead to heart failure. Treatment can help. Some people with cardiomyopathy eventually need a heart transplant.

Cardiomyopathy is common and can affect anyone of any age, sex or race.

Types

The main types of cardiomyopathy are:

• Dilated cardiomyopathy
• Hypertrophic cardiomyopathy
• Restrictive cardiomyopathy

Other types include:

• Ischemic cardiomyopathy
• Arrhythmogenic right ventricular cardiomyopathy (ARVC)
• Transthyretin amyloidosis cardiomyopathy (ATTR-CM)
• Broken heart syndrome (stress-induced or takotsubo cardiomyopathy)
• Chemotherapy-induced cardiomyopathy
• Alcohol-induced cardiomyopathy
• Left ventricular non-compaction (LVNC)
• Peripartum cardiomyopathy
• Sepsis-induced cardiomyopathy

You can inherit some types of cardiomyopathy. Others develop because of another condition, certain medications or pregnancy. Some types are much more common than others.

Symptoms of cardiomyopathy

Cardiomyopathy symptoms include:

• Fatigue
• Heart palpitations
• Chest pain
• Abnormal heart rhythm (arrhythmia)
• Shortness of breath
• Swelling in your lower body
• Fainting

Some people have no symptoms of cardiomyopathy and don’t need treatment. Others develop symptoms as the disease advances. Without treatment, symptoms may get worse over time.

Cardiomyopathy causes

Causes of cardiomyopathy include genes you get from your biological parents. Researchers have found more than 1,000 genetic variations that cause cardiomyopathies.

Other cardiomyopathy causes include:

• Coronary artery disease
• High blood pressure
• Autoimmune diseases
• Infections and inflammation that affect your heart muscle
• Metabolic conditions, like diabetes and thyroid disease
• Heart valve disease
• Muscular dystrophy
• High cholesterol diseases
• Sarcoidosis
• Amyloidosis
• Hemochromatosis

Sometimes, experts don’t know the cause.

Risk factors

Cardiomyopathy risk factors include:

• History of heart failure, cardiomyopathy or sudden cardiac arrest in your biological family
• Personal history of heart attacks
• Long-term use of cocaine or alcohol
• Pregnancy
• A highly stressful experience, like the loss of a loved one
• Radiation or chemotherapy to treat cancer
• A body mass index (BMI) higher than 30

How to lower your risk

You can take action to reduce your risk of conditions that could lead to cardiomyopathy. For example:

• Manage your blood pressure.
• Keep your cholesterol in a healthy range.
• Get regular exercise.
• Avoid tobacco products, alcohol and cocaine.
• Manage conditions like sleep apnea and diabetes.
• Schedule regular checkups with a healthcare provider.
• Take all medications as prescribed.

You can’t prevent congenital (inherited) types of cardiomyopathy, but you can let relatives know that you have it. Your relatives can talk to their healthcare providers to see if they’re at risk for cardiomyopathy or have it. Early diagnosis helps people make a plan for managing their condition.

Complications of this condition

As cardiomyopathy worsens, you may develop other heart problems, like:

• Arrhythmias (irregular heartbeats): These can happen when your heart doesn’t pump well.
• Heart failure: Your heart muscle becomes weaker and can’t pump and/or relax well.
• Stroke: When your heart can’t pump well, a blood clot can form and go to your brain.
• Heart valve disease: Weakness in your heart can damage its valves.
• Cardiac arrest: With weakened muscle, your heart can stop beating.
• Cardiogenic shock: Your organs may not receive enough blood if your heart can’t pump well.

How doctors diagnose cardiomyopathy

Your healthcare provider will ask about your medical history and that of your family. They’ll also do a physical exam.

If they suspect you have a heart condition, they’ll refer you to a cardiologist (heart specialist). A cardiologist performs a full assessment that may include a range of diagnostic tests.

Tests to diagnose cardiomyopathy may include:

• Event monitors: Record abnormal heart rhythms that happen off and on
• Blood tests: Check for signs of heart damage or inherited cardiomyopathy
• Chest X-ray: Can show heart enlargement or fluid buildup in your lungs
• Cardiac CT: Can show your heart’s shape, size, muscle, valves and arteries
• Heart MRI: Can suggest which type of the disease you have and show a complete picture of your heart muscle
• Echocardiogram: Looks at your heart valves and shows how well your heart pumps
• Electrocardiogram (EKG): Records your heart’s electrical activity
• Exercise stress test: Reveals how well your heart works under stress
• Cardiac catheterization: Checks for blockages and other blood flow problems in your heart’s arteries
• Myocardial biopsy: Removes a heart muscle sample to check for disease

How is it treated?

Cardiomyopathy treatments don’t cure the condition. But they can help manage symptoms and slow disease progression. Your healthcare provider may recommend lifestyle changes, medications, devices or procedures. They’ll decide your treatment based on which type of cardiomyopathy you have and how advanced it is.

Lifestyle changes

Changing how you live day-to-day can strengthen your heart. Ways to do this include:

• Eating food that’s low in fat and salt
• Staying at a weight that’s healthy for you
• Getting regular physical activity
• Getting the amount of sleep you need
• Reducing your stress level
• Avoiding the use of tobacco products and alcohol

Medications

Medications can improve your heart function, manage symptoms and reduce your risk of complications. Your provider may prescribe:

• Blood pressure medicines
• Blood thinners (anticoagulants)
• Antiarrhythmics
• Medications to lower cholesterol
• Aldosterone antagonists
• Corticosteroids

Devices

Devices a provider puts into your body can treat irregular heart rhythms. These devices monitor your heartbeat. They send electrical impulses to your heart when an arrhythmia starts. You may receive one of these devices:

• Pacemaker
• Implantable cardioverter defibrillator (ICD)

Some devices help your heart pump blood more efficiently. These include:

• Cardiac resynchronization therapy (CRT)
• Left ventricular assist device (LVAD)

Surgeries and procedures

If you have severe symptoms or underlying heart conditions, your provider may recommend a procedure. This is rare.

Procedures may include:

• Septal myectomy
• Heart transplant
• Alcohol septal ablation (for your heart muscle)
• Catheter ablation (for dangerous or problematic heart rhythms)

Some of these involve surgery. Providers usually only recommend open heart surgery or a heart transplant when all other treatments have failed to bring relief. Most people with cardiomyopathy can manage their condition with medicines.

When should I see my healthcare provider?

You’ll need regular checkups to monitor your heart’s health. Also, you may need regular blood tests or other tests that tell your provider how well your heart is doing.

Contact your provider if you have:

• New symptoms
• Worsening symptoms
• Side effects from medications
• Trouble with your device (pacemaker or defibrillator)

Get emergency medical care if you have:

• Chest pain
• Heart palpitations
• Fainting

Before your appointment, make a list of your symptoms, medications and any family history of heart disease to discuss with your provider.

What can I expect if I have this condition?

Cardiomyopathy is a serious condition. Without treatment, it can be life-threatening. It also usually worsens over time. But treatment can improve your outlook. Medication, procedures or other treatments can help you live longer.

The length of time that you have cardiomyopathy depends on the type you have. The severity of your condition matters, too. Takotsubo cardiomyopathy usually doesn’t last long. Cardiomyopathy from alcohol may only last a few months. You may be able to reverse cardiomyopathy from chemotherapy.

For other types, you’ll need to manage your symptoms for the rest of your life. Many people don’t have major problems from cardiomyopathy, but some do.

There’s no cure for cardiomyopathy. But you can manage the condition or slow its progression. Taking the right medications can drastically alter and improve your prognosis. Many people can live healthy lives with the right treatment.