Cardiomyopathy

Answer 1

Definition

Cardiomyopathy is a weakening of the heart muscle or a change in heart muscle structure. It is often associated with inadequate heart pumping or other heart function problems.

Causes, incidence, and risk factors

Common types of cardiomyopathy include:

• Dilated cardiomyopathy is a condition in which the heart becomes weakened and enlarged. It cannot pump blood efficiently. Many different medical problems can cause this type of cardiomyopathy.
• Hypertrophic cardiomyopathy (HCM) is a condition in which the heart muscle becomes thick. This thickening makes it harder for blood to leave the heart. This type of cardiomyopathy is usually passed down through families.
• Restrictive cardiomyopathy refers to a group of disorders in which the heart chambers are unable to properly fill with blood because of increased stiffness in the heart.

Common causes of cardiomyopathy are:

• Alcoholism and cocaine use
• Amyloidosis
• Chemotherapydrugs
• Coronary artery disease
• End-stage kidney disease
• Genetic defects
• High blood pressure (hypertension)
• Infections due to viruses, HIV, Lyme disease, Chagas disease
• Nutritional deficiencies (such as selenium, thiamine, calcium)
• Pregnancy
• Systemic lupus erythematosus

Please see the linked articles for details on a specific type of cardiomyopathy:

• Dilated cardiomyopathy
• Hypertrophic cardiomyopathy
• Restrictive cardiomyopathy
• Ischemic cardiomyopathy
• Peripartum cardiomyopathy (occurs during or in the first 5 months after pregnancy)

Treatment

When the cause of dilated cardiomyopathy can be identified, efforts are aimed at treating that condition (for example, treating high blood pressure or coronary artery disease, or stopping alcohol or cocaine use). Sometimes, no specific cause can be identified.

Attempts are also made to find a "trigger" that may have caused a patient's symptoms to suddenly get worse. Examples include:

• Drinking alcohol
• Increasing salt or fluid intake
• Not taking medications correctly
• Using recreational drugs, especially stimulants such as cocaine

The overall treatment of cardiomyopathies is focused on treating heart failure. However, each type of cardiomyopathy may be treated differently.

Expectations (prognosis)

The outlook depends on many different things, including:

• Cause of the cardiomyopathy
• How well you respond to treatment
• Severity of the heart problem
• Type of cardiomyopathy

The disorder is long-term (chronic) and the condition may get worse very quickly.

References

Hare JM. The dilated, restrictive, and infiltrative cardiomyopathies. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. St. Louis, Mo: WB Saunders; 2007:chap 64.

Bernstein D. Diseases of the myocardium. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 439.

Wexler RK, Elton T, Pleister A, Feldman D. Cardiomyopathy: An overview. Am Fam Physician. 2009;79:778-784.

Answer 2

In this case of cardiomyopathy, part of the septum dividing the ventricles is interfering with the normal emptying of the left ventricle. This is one variety of the condition called hypertrophic obstructive cardiomyopathy (HOCM). A catheter is introduced into the heart and through it, concentrated alcohol is applied to the abnormal area, shrinking it, allowing the heart to function normally.

Reviewed By

Review Date: 11/08/2010

Glenn Gandelman, MD, MPH, FACC Assistant Clinical Professor of Medicine at New York Medical College, and in private practice specializing in cardiovascular disease in Greenwich, CT. Review provided by VeriMed Healthcare Network. Previously reviewed by Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington (5/17/2010).

Answer 3

Definition

Cardiomyopathy is a weakening of the heart muscle or a change in the heart muscle. It often occurs when the heart cannot pump as well as it should, or with other heart function problems.

Most patients with cardiomyopathy have heart failure.

Causes, incidence, and risk factors

Common types of cardiomyopathy include:

• Dilated cardiomyopathy is a condition in which the heart becomes weak and large. It cannot pump blood well enough. Many different medical problems can cause this type of cardiomyopathy.
• Hypertrophic cardiomyopathy (HCM) is a condition in which the heart muscle becomes thick. This thickening makes it harder for blood to leave the heart. This type of cardiomyopathy is usually passed down through families.
• Ischemic cardiomyopathy is caused by narrowing of the arteries that supply the heart with blood.
• Restrictive cardiomyopathy is a group of disorders in which the heart chambers are unable to properly fill with blood because the heart muscle is stiff.
• Peripartum cardiomyopathy occurs during pregnancy or in the first 5 months afterward.

Common causes of cardiomyopathy are:

• Alcoholism and cocaine use
• Amyloidosis
• Chemotherapydrugs
• Coronary artery disease (ischemic cardiomyopathy) -- most common cause
• End-stage kidney disease
• Genetic defects
• High blood pressure (hypertension)
• Infections due to viruses -- HIV, Lyme disease, Chagas disease
• Nutritional deficiencies (such as selenium, thiamine, and calcium)
• Pregnancy
• Systemic lupus erythematosus

For more information on the different types of cardiomyopathy, see also:

• Dilated cardiomyopathy
• Hypertrophic cardiomyopathy
• Restrictive cardiomyopathy
• Ischemic cardiomyopathy
• Peripartum cardiomyopathy

Treatment

The conditions that cause dilated cardiomyopathy are treated. Heart failure is treated by:

• Taking medicines
• Making important changes in your lifestyle (dieting, exercising, stopping smoking, stopping alcohol use or using it only in moderation, and stopping the use of other substances such as illegal drugs)
• Knowing your body and the symptoms of heart failure
• Wearing a pacemaker to treat a slow heart rate or to help both sides of your heart beat at the same time
• Wearing a defibrillator that sends an electrical pulse to stop life-threatening, abnormal heart rhythms

See also: Heart failure

A cardiac catheterization may be done to see if you need coronary artery bypass(CABG) surgery or a balloon procedure (angioplasty), whcih can immprove blood flow to the damaged or weakened heart muscle. It may also be done to measure pressures and check your heat function (called right-heart catheterization).

If you have tried all of the standard treatments and still have very severe symptoms, you may need a heart transplant. Recently, implantable artificial heart pumps have been developed. However, very few patients are able to have this advanced treatment.

Expectations (prognosis)

The outlook depends on many different things, including:

• Cause and type of cardiomyopathy
• How well you respond to treatment
• How severe the heart problem is

Often, you can control heart failure with medicine, lifestyle changes, and by treating the condition that caused it.

Heart failure may suddenly become worse due to:

• Angina
• Eating high-salt foods
• Heart attack
• Infections or other illnesses
• Not taking your medicine correctly

Heart failure is usually a long-term (chronic) illness. It may get worse over time. Some people develop severe heart failure that medicines, surgery, and other treatments can no longer help.

Patients with certain types of cardiomyopathy and heart failure are at risk for dangerous heart rhythm problems.

References

Bernstein D. Diseases of the myocardium. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 439.

Hare JM. The dilated, restrictive, infiltrative cardiomyopathies. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 68.

Wexler RK, Elton T, Pleister A, Feldman D. Cardiomyopathy: An overview. Am Fam Physician. 2009;79:778-784.

Reviewed By

Review Date: 05/23/2011

Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.