Fast facts

  • Cardiomyopathy is any condition that affects the heart muscle.

  • There are several types of cardiomyopathy, each with its own causes and treatments.

  • Treatment of cardiomyopathy aims to help you to manage your condition while living a fulfilling life.

  • Lifestyle changes, medications, medical devices and surgery can be used to treat and manage cardiomyopathy.

 

What is cardiomyopathy?

Cardiomyopathy is the name given to a number of conditions that affect the heart muscle. The heart muscle thin, thicken or stiffen - which can make it difficult for your heart to effectively pump blood around your body. This can sometimes lead to heart failure, which causes fluid to build up in the lungs, abdomen, legs, feet or ankles.

Heart failure

A condition in which the heart is too weak to effectively pump blood throughout the body.

Signs and symptoms

Cardiomyopathy can cause no symptoms for many people, particularly in its early stages. As the condition worsens, signs and symptoms of heart failure can appear, including:

  • Difficulty breathing;
  • Shortness of breath, particularly when exercising;
  • Tiredness or fatigue;
  • Swelling in the abdomen, feet, ankles or legs;
  • Lung crackles, indicating fluid build-up on the lungs;
  • Dizziness and fainting;
  • Irregular heartbeats, and;
  • Chest pain.

Fatigue

A state of exhaustion and weakness.

Heart failure

A condition in which the heart is too weak to effectively pump blood throughout the body.

Causes and risk factors

The specific cause of cardiomyopathy is often not known. Causes and triggers that may lead to the development of the condition include:

  • Genetics. It is possible that certain gene mutations are inherited that give people an increased risk of developing the condition. This may be the cause in about 30% of dilated cardiomyopathy cases (see below); [1]
  • Viral infections, including adenoviruses and enteroviruses, that can target particular cells within the heart. Not all people affected by these viruses will develop cardiomyopathy;
  • An autoimmune response developing against your heart cells;
  • Tachycardias. These are heart rates that are faster than normal. Examples of tachycardia include supraventricular tachycardia and atrial fibrillation;
  • Toxic agents that specifically affect heart cells in some people. These can include chemotherapy drugs, alcohol, cocaine and other narcotics;
  • Heart attacks can damage the heart muscle and sometimes cause scarring. Scar tissue can affect the way that electrical impulses flow around the heart and prevent it from beating normally, and;
  • Hypertension, which can place additional strain on the heart.

Adenoviruses

A family of viruses that cause primarily respiratory diseases, conjunctivitis and gastroenteritis.

Autoimmune response

A medical condition in which the body's immune system abnormally targets substances that are normally found within the body.

Cells

The fundamental unit of life; the simplest living unit that can exist, grow, and reproduce independently. The human body is composed of trillions of cells of many kinds.

Chemotherapy

A medication-based treatment, usually used in the treatment of cancers. There are numerous, different types of chemotherapy drugs that can be prescribed by a specialist. These can commonly be used alongside other cancer treatments such as surgery and radiotherapy.

Gene

A unit of inheritance (heredity) of a living organism. A segment of genetic material, typically DNA, that specifies the structure of a protein or related molecules. Genes are passed on to offspring so that traits are inherited, making you who you are and what you look like.

Genetics

Related to genes, the body's units of inheritance or origin.

Infections

Entry into the body of microorganisms that can reproduce and cause disease.

Viral

Pertaining to an illness caused by a virus.

Enteroviruses

A group of viruses that multiply in the gut and attack the central nervous system causing conditions such as polio, hepatitis A, meningitis, and hand, foot and mouth disease.

narcotics

Any substance that has the effect of reducing pain and/or inducing sleep.

1. Watkins, H., Ashrafian, H. and Redwood, C. (2011) Inherited cardiomyopathies. The New England Journal of Medicine 364:1643–1656. doi:10.1056/NEJMra0902923.

Types

There are four types of cardiomyopathy: dilated, hypertrophic, restrictive and arrhythmogenic right ventricular. Each type of cardiomyopathy affects the heart muscle in a different way.

Dilated cardiomyopathy

In dilated cardiomyopathy, the heart enlarges, causing the heart muscle to stretch and become thinner. When this occurs, the heart cannot contract like it normally would, and has trouble pumping blood around the body. As the heart becomes weaker, heart failure can occur.

Dilated cardiomyopathy can also lead to irregular heartbeats, heart valve problems and blood clots in the heart due to blood pooling in its chambers and not being pumped out. This condition affects more men than women, and usually occurs between 20-60 years of age.

Hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy occurs when the heart muscle walls thicken. This happens when many individual cells within the heart grow larger, and together they can block the flow of blood from ventricles.

The heart must then work harder to move blood around the body, leading to chest pain and shortness of breath. Hypertrophic cardiomyopathy is common, affecting around one in 500 people at any age. [2]

Restrictive cardiomyopathy

Restrictive cardiomyopathy involves the heart muscle becoming stiff. This is due to abnormal heart tissue - usually scar tissue - replacing normal heart muscle. This can affect how well the heart can pump blood and can lead to heart failure and arrhythmias. Restrictive cardiomyopathy usually affects older adults.

Arrhythmogenic right ventricular cardiomyopathy

This involves changes in the heart's electrical system. Part of the healthy heart muscle tissue is replaced with scar tissue, which prevents the electrical circuitry in the heart from working properly, causing irregular heartbeats. Symptoms can include palpitations and fainting. This type of cardiomyopathy usually affects younger people, including teenagers and young adults.

A healthy heart and the four types of cardiomyopathy. 

Arrhythmias

An abnormal or irregular heart rhythm.

Cells

The fundamental unit of life; the simplest living unit that can exist, grow, and reproduce independently. The human body is composed of trillions of cells of many kinds.

Heart failure

A condition in which the heart is too weak to effectively pump blood throughout the body.

Clots

The thickened or solid mass formed from a liquid, such as blood. Blood clots normally form at an injury site to prevent further blood loss.

Ventricles

1. The two main heart chambers that eject blood back out of the heart. 2. A series of connecting cavities in the brain that contain the cerebrospinal fluid, which supports and protects the brain.

Heart valve

A structure within the heart that controls the direction of blood flow through the heart.

2. Cardiomyopathy. The Heart Foundation. Accessed 9 December 9 2014, from

External link

Methods for diagnosis

In some cases, cardiomyopathy does not have any symptoms, particularly in the early stages. This is because the heart can often compensate for any problems it has by working harder. To make a diagnosis, your doctor will look at your symptoms, conduct a physical examination and perform some diagnostic tests including a chest X-ray, echocardiography, electrocardiography and blood tests. To help identify the cause of your cardiomyopathy, a biopsy of heart muscle (endomyocardial biopsy) may be performed.

Chest X-ray

A chest X-ray can show whether the cardiac muscle is enlarged, or if there is fluid build-up caused by heart failure.

Echocardiography

Echocardiography allows your doctor to see the size of your heart and also how well it is working. It can show how hard your heart is pumping blood, whether it is leaking and highlight areas of damage. This can also indicate what type of damage the heart has sustained.

Electrocardiography

Electrocardiography (ECG) is used to determine if there are any abnormalities in your heart's rhythm. This can be particularly important when diagnosing restrictive cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy.

Electrocardiography procedure.An electrocardiography procedure. 

Stress test

A stress test involves assessing your heart while it is under stress, or beating fast. This can be done while exercising, or after taking medication that makes your hear beat faster.

Coronary angiograph

A coronary angiograph is used to give an image of the coronary arteries, which supply the heart with blood, and of the pumping function of the heart. A special dye is injected into the arteries near the heart, and then images are taken. The way the dye shows up in the images show how the dye travels through the heart and nearby blood vessels.

Ejection fraction

The ejection fraction is the amount of blood that is ejected out of the left ventricle with each heartbeat. This measurement can give an indication of how well the heart is pumping blood and indicate if there is evidence of heart failure.

Endomyocardial biopsy

An endomyocardial biopsy is a very small piece of tissue taken from the heart and examined under a microscope. This can be used to see whether any changes in cells have occurred. It can be particularly useful for identifying if your cardiomyopathy was caused by a viral infection.

Arteries

A blood vessel carrying blood saturated with oxygen from the heart to the body's tissues.

Blood tests

During a blood test, blood can be drawn using a needle or by a finger prick. Your blood can then be analysed to help diagnose and monitor a wide range of health conditions.

Cells

The fundamental unit of life; the simplest living unit that can exist, grow, and reproduce independently. The human body is composed of trillions of cells of many kinds.

Echocardiography

The procedure in which ultrasound waves are used to create an image of the heart, to allow assessment of the heart's function as it beats.

Heart failure

A condition in which the heart is too weak to effectively pump blood throughout the body.

Infection

Entry into the body of microorganisms that can reproduce and cause disease.

Viral

Pertaining to an illness caused by a virus.

X-ray

A scan that uses ionising radiation beams to create an image of the body’s internal structures.

Ventricle

1. The two main heart chambers that eject blood back out of the heart. 2. A series of connecting cavities in the brain that contain the cerebrospinal fluid, which supports and protects the brain.

Electrocardiography

A test that uses electrodes placed on the chest and limbs to record the electrical impulses causing the contractions of the heart.

2. Cardiomyopathy. The Heart Foundation. Accessed 9 December 9 2014, from

External link

Types of treatment

Treatment of cardiomyopathy aims to help you to manage your condition while living a fulfilling life. A main focus of treatment is to identify and treat any underlying condition that has caused your cardiomyopathy.

Treatments can include lifestyle changes, medications, surgery or medical devices.

Lifestyle changes

Some lifestyle changes include regular light physical activity, reducing excess body fat, not smoking, eating a healthy diet that is low in fat and salt, limiting alcohol intake and getting adequate rest. If heart failure worsens due to cardiomyopathy, your doctor may recommend a daily limit on the amount of fluids you drink.

Medications

To treat the various forms of cardiomyopathy, a combination of medications may be required. Depending on your symptoms, some medications can include:

Diuretics

Diuretics, such as frusemide, remove excess fluid from your body by making you urinate more often. Sometimes, diuretics can also cause your body to lose natural minerals, including magnesium and potassium, so your doctor may monitor the levels of these in your blood and prescribe supplements if needed.

Angiotensin-converting enzyme (ACE) inhibitors

ACE inhibitors are vasodilators that can reduce blood pressure by widening blood vessels. This can ease the strain on the heart and lead to a reduction in your body's salt and water retention. Some examples include enalapril, lisinopril and captopril.

Beta-blockers

These medications work by slowing your heart rate and reducing your blood pressure. Some examples include carvedilol, metoprolol and bisoprolol.

Digoxin

Digoxin, also known as digitalis, helps your heart to pump more effectively by increasing the strength of your heart muscle contractions. Digoxin also tends to slow down the heart rate and regulate a normal rhythm.

Additional medications

Along with your cardiomyopathy medications, your doctor might also prescribe other medications. These can include a statin (a cholesterol-lowering medication) if required, nitrates for chest pain, or blood-thinning medications (warfarin) to prevent blood clots.

Surgery and medical devices

In some cases of cardiomyopathy, surgery or medical devices may be needed. These can include:

Implantable cardioverter-defibrillators (ICDs)

These are small electrical devices surgically placed in your chest. The ICD can pace your heart to a normal rhythm, or automatically defibrillate (shock) your heart if you develop a dangerous rhythm.

Left ventricular assist devices (LVDs)

These are heart pumps that are surgically inserted and attached to a damaged heart. Powered by an external battery pack, they can be used as a substitute for a heart transplant, or while you wait for a donor heart to become available.

Septal myectomy

A septal myectomy is used for people with hypertrophic cardiomyopathy. This involves open heart surgery to remove part of the thickened wall of the heart to improve blood flow from the heart.

Heart transplant

In some cases, when other treatments are not successful, a donor heart may be required.

Blood pressure

The pressure the blood places on the walls of the arteries, largely mirroring the contraction of the heart, and consisting of two readings. The higher reading is systolic blood pressure, when the heart contracts, and the lower is diastolic blood pressure, when the heart is relaxed.

Heart failure

A condition in which the heart is too weak to effectively pump blood throughout the body.

Nitrates

Chemical compounds containing a particular chemical group made up of one nitrogen atom and three oxygen atoms. These can be used to dilate blood vessels and also as preservatives in food.

Potassium

A water-soluble compound and major mineral that is essential for maintaining contractions of muscles, including the heart.

Magnesium

An important mineral that is essential for the development of bones and teeth, energy production and muscle contraction.

Clots

The thickened or solid mass formed from a liquid, such as blood. Blood clots normally form at an injury site to prevent further blood loss.

2. Cardiomyopathy. The Heart Foundation. Accessed 9 December 9 2014, from

External link

Potential complications

Some complications associated with cardiomyopathy include:

Heart failure

Heart failure is a condition in which your heart is unable to pump enough blood around your body. This can lead to blood 'damming up' behind the heart, causing fluid to collect in your lungs or other body tissue.

Stroke

A stroke is when a blood clot blocks a blood vessel in your brain. During heart failure, blood may travel more slowly through the heart. This can lead to the formation of clots and increase your risk of having a stroke.

Kidney failure

Reduced blood flow caused by cardiomyopathy can cause your kidneys to fail. If you suffer significant kidney damage, you may require dialysis.

Heart valve problems

If your heart becomes enlarged, or the pressure within your heart becomes very high, your heart valves may not work properly.

Dialysis

A mechanical blood-filtering treatment that mimics the function of your kidneys, which normally work as your body’s natural filtration system to remove the body's waste products from the blood.

Heart failure

A condition in which the heart is too weak to effectively pump blood throughout the body.

Kidneys

A pair of organs responsible primarily for regulating the water balance in the body and filtering the blood.

Clot

The thickened or solid mass formed from a liquid, such as blood. Blood clots normally form at an injury site to prevent further blood loss.

2. Cardiomyopathy. The Heart Foundation. Accessed 9 December 9 2014, from

External link

Prognosis

Cardiomyopathy is a life-threatening condition. In some cases, with correct treatment, symptoms can subside and heart function can improve. Depending on your condition, lifestyle changes, medication, or occasionally surgery can help give you a better quality of life.

2. Cardiomyopathy. The Heart Foundation. Accessed 9 December 9 2014, from

External link

Prevention

It is not possible to prevent inherited forms of cardiomyopathy, but it is possible to live a healthy lifestyle and limit risk factors of the condition occurring. This can involve exercising regularly, limiting alcohol, and avoiding viral and toxic agents that can damage your heart. It is also important to treat any conditions that can lead to cardiomyopathy, such as hypertension, as soon as they are identified.

Genetic testing in those with a family history of cardiomyopathy can allow for early detection and treatment.

Genetic

Related to genes, the body's units of inheritance or origin.

Viral

Pertaining to an illness caused by a virus.

2. Cardiomyopathy. The Heart Foundation. Accessed 9 December 9 2014, from

External link