Cardiomyopathy is a disease that affects the heart muscle and makes it harder for the heart to pump blood. It can cause shortness of breath, chest pain, swelling, irregular heartbeats and, in some cases, sudden death.
Cardiomyopathy, sometimes called heart muscle disease, can develop at any age. Possible causes include high blood pressure, a heart attack, heart failure, excessive alcohol consumption, diabetes, obesity and genetic changes.
Anyone with symptoms that may indicate cardiomyopathy should see a cardiologist or primary care provider for a complete evaluation. Treatment depends on the cause and severity and may include medication, lifestyle changes, surgery or a heart transplant.
Main symptoms
The main symptoms of cardiomyopathy are:
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Shortness of breath or difficulty breathing;
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Chest pain;
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Fatigue;
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Swelling in the ankles, feet, legs and abdomen;
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Dizziness;
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Irregular heartbeats;
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Fainting;
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Unusual heart sounds.
In babies and children, cardiomyopathy may cause vomiting, diarrhea, difficulty eating or breathing, irritability and poor growth.
Some people with cardiomyopathy never develop symptoms. Others begin to notice symptoms as the condition gets worse.
Types of cardiomyopathy
The main types of cardiomyopathy vary according to how the heart muscle is affected:
1. Hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy is a genetic condition that causes the heart muscle to become abnormally thick. It usually develops during childhood or early adulthood.
Common symptoms of hypertrophic cardiomyopathy include fatigue, shortness of breath, chest pain, palpitations and fainting. This type of cardiomyopathy can also cause sudden death in adolescents and young athletes.
2. Dilated cardiomyopathy
Dilated cardiomyopathy is characterized by impaired contraction and enlargement of one or both ventricles of the heart.
The condition may have no identifiable cause or may develop because of a family predisposition, viral infections, Chagas disease, Lyme disease or alcohol misuse, for example.
Dilated cardiomyopathy can develop at any age. It may cause shortness of breath during sleep, difficulty breathing while lying down, swollen legs, fatigue and a general feeling of being unwell. In more severe cases, it can lead to thromboembolism, arrhythmias, heart failure and death.
3. Takotsubo cardiomyopathy
Takotsubo cardiomyopathy, also known as stress cardiomyopathy, is a condition in which the heart muscle suddenly becomes weakened and cannot pump blood effectively. It may develop after unexpected physical or emotional stress.
Also called broken heart syndrome, this type of cardiomyopathy can cause symptoms similar to those of a heart attack. These may include chest pain, shortness of breath, fatigue, abnormal heartbeats, palpitations, low blood pressure and fainting.
4. Chagas cardiomyopathy
Chagas cardiomyopathy develops because of inflammation in the heart caused by infection with the Trypanosoma cruzi parasite. It may cause shortness of breath, fatigue, arrhythmias, fainting, swelling in the arms and legs, chest pain, thromboembolism and sudden death.
5. Restrictive cardiomyopathy
Restrictive cardiomyopathy is rare and mainly affects older adults. It may be caused by radiation therapy, medications such as anthracyclines, busulfan and methysergide, or conditions such as amyloidosis, sarcoidosis and diabetes.
Symptoms of restrictive cardiomyopathy may include abdominal swelling, swelling in the legs and feet, arrhythmias and extreme fatigue during physical activity.
6. Alcoholic cardiomyopathy
Alcoholic cardiomyopathy causes the heart to become enlarged and weakened, reducing its ability to pump blood effectively. It is more common in people with alcohol use disorder or genetic mutations that slow the metabolism of alcohol.
Also known as alcohol-induced cardiomyopathy, this condition can cause symptoms of heart failure, including shortness of breath, palpitations and fainting.
7. Peripartum cardiomyopathy
Peripartum cardiomyopathy, also known as postpartum cardiomyopathy, is a rare type of heart failure that develops near the end of pregnancy or during the months after delivery. It is diagnosed when no other cause of heart failure can be identified.
Possible symptoms include fatigue, low blood pressure, shortness of breath and swelling in the legs and abdomen.
How the diagnosis is confirmed
A cardiologist diagnoses cardiomyopathy by evaluating the person’s symptoms, clinical signs and medical history.
To confirm the diagnosis, the doctor may order tests such as a complete blood count, a heart biopsy and imaging tests. These may include magnetic resonance imaging, an echocardiogram, an electrocardiogram and a chest X-ray.
The cardiologist may also recommend genetic testing and an exercise stress test, which evaluates how the heart works during physical activity.
Possible causes
Possible causes of cardiomyopathy include:
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Long-term high blood pressure;
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Hemochromatosis;
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Excessive alcohol consumption;
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Heart attack;
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Metabolic conditions, such as obesity and diabetes;
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Sarcoidosis;
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Amyloidosis.
A family history of cardiomyopathy, heart failure or sudden cardiac arrest can also increase the risk of developing cardiomyopathy.
Difference between cardiomyopathy and heart disease
Heart disease is a broad term for conditions that affect any part of the heart. These include cardiomyopathy, coronary artery disease, high blood pressure and heart valve disorders.
Cardiomyopathy refers specifically to diseases that affect the heart muscle, which is known as the myocardium.
How treatment is performed
Treatment for cardiomyopathy depends on its cause and severity and may include:
1. Medications
Medications that a doctor may prescribe include:
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Blood-thinning medications, such as warfarin, aspirin and rivaroxaban, to help prevent blood clots in people with dilated, Takotsubo or hypertrophic cardiomyopathy;
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Beta-blockers, such as atenolol, metoprolol and bisoprolol, which may be used to treat hypertrophic, Takotsubo, restrictive, alcoholic and dilated cardiomyopathy;
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Non-dihydropyridine calcium channel blockers, such as verapamil, which may be recommended for people with hypertrophic cardiomyopathy;
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Diuretics, which may be prescribed for people with hypertrophic, dilated, peripartum, alcoholic or restrictive cardiomyopathy;
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Corticosteroids, which may be prescribed when cardiomyopathy is associated with sarcoidosis.
Angiotensin-converting enzyme inhibitors, such as enalapril, ramipril and captopril, may also be prescribed for dilated, Takotsubo, peripartum or restrictive cardiomyopathy.
2. Heart transplant
A heart transplant replaces the diseased heart with a healthy heart from a donor. It may be recommended for advanced heart failure associated with restrictive, hypertrophic or dilated cardiomyopathy, for example.
3. Surgery
Alcohol septal ablation may be recommended for hypertrophic cardiomyopathy to relieve symptoms, improve exercise capacity and enhance quality of life.
Ventricular myectomy, mitral valve replacement, permanent pacemaker implantation or implantable cardioverter-defibrillator placement may be recommended for people with hypertrophic or restrictive cardiomyopathy.
4. Lifestyle changes
Avoiding alcohol is recommended for all people with cardiomyopathy, especially those with alcoholic cardiomyopathy.
Other lifestyle changes that can help manage cardiomyopathy include exercising regularly as recommended by a healthcare provider, maintaining a healthy body weight, getting enough sleep, managing stress and following a healthy diet.
Can cardiomyopathy be cured?
Cardiomyopathy has no cure. However, appropriate treatment and lifestyle changes can help control symptoms and prevent complications.