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Cardiomyopathy: Causes, Symptoms, Treatment and Prevention

Cardiomyopathy (a.k.a heart muscle disease) is a disease that affects the heart muscles (myocardium). The heart muscles are responsible for pumping blood to the different parts of the body.

Cardiomyopathy

What is Cardiomyopathy?

In cardiomyopathy, the pumping ability of the heart is affected which leads to heart dysfunction and failure. Cardiomyopathy affects people of all age-groups. It is a life-threatening condition and need immediate treatment to prevent severe complications like heart attack and heart failure.

Types of Cardiomyopathy:

Cardiomyopathy is of different types, they are:

  • Dilated cardiomyopathy: In this type, the heart muscle become thin and stretched out.
  • Hypertrophic cardiomyopathy: In this condition, there heart muscles cells become large in size and the walls of the heart thicken.
  • Restrictive cardiomyopathy: In this condition, the heart muscles lose elasticity and become inflexible.

Causes of Cardiomyopathy:

The specific cause of cardiomyopathy is not known. Most of the cases of cardiomyopathy are hereditary. Genetic mutations in the cells of the cardiac muscle, may lead to the development of this disease.

Other contributing factors for cardiomyopathy include:

  • High blood pressure
  • Previous history of heart attack
  • Chronic rapid heartbeat
  • Underlying conditions like diabetes, obesity
  • Exposure to radiotherapy and chemotherapy, as part of cancer treatment
  • Accumulation of iron in the heart muscle (hemochromatosis)
  • Drug and substance abuse
  • Inflammatory conditions like rheumatic fever

Symptoms of Cardiomyopathy:

Symptoms do not occur in the initial stages of the disease. But, they become evident as the disease progresses. Some of the common symptoms include:

  • Shortness of breath present at rest and on activity
  • Chest discomfort
  • Swelling in the legs and ankle
  • Heaviness in the abdomen due to fluid accumulation
  • Fluttering or pounding heart beat
  • Generalised weakness
  • Dizziness
  • Cough in sleeping position

Risk Factors of Cardiomyopathy:

The following are factors that increase the risk of cardiomyopathy:

  • Family history of any heart related problems like heart attack
  • Chronic high blood pressure
  • Previous history of heart attack
  • Underlying primary diseases like diabetes and hyperthyroidism
  • Post radiotherapy or chemotherapy treatment
  • Obesity or overweight
  • Excess intake of alcohol regularly
  • Excess smoking
  • Long-term use of steroids

Complications of Cardiomyopathy:

Cardiomyopathy if not treated promptly may lead to the following complications like:

  • Heart failure
  • Blood clots within the heart
  • Heart valve diseases
  • Cardiac arrest
  • Death

Diagnosis of Cardiomyopathy:

Diagnosis of the patient involves physical examination and history taking of the patient.

History taking involves taking details about the present medical condition, past medical history and family history. Physical examination includes using a stethoscope to analyze the heart sounds; and observing the hands and legs to check for any abnormal swelling.

If the clinical assessment findings indicate cardiomyopathy, the doctor may recommend for further diagnostic tests, such as:

Chest x-ray:

In this test, x-rays are used to determine the size of the heart and also to view the other structures in the chest. Any increase in the size of the heart is easily identifiable in X ray scans.

Echocardiogram:

In this test, sound waves are used to determine the size of the heart and movements of the heart muscle when it beats. It is also useful to analyses the function of the heart valves.

Electrocardiogram (ECG):

The electrocardiogram (ECG) determines the electrical activity of the heart at rest and on activity. Any irregularities in the heart rate and rhythm can be recorded.

Exercise Stress Test:

This test helps to monitor the heart activity when a patient is doing exercise (usually by using a treadmill). Patient with cardiomyopathy may not show symptoms at rest in the initial stages. However, when the workload on heart increases (as during exercise), certain signs and symptoms become evident. In this test, a patient’s ECG and blood pressure is continuously monitored while he/she is performing exercise with progressive increase in intensity.

Holter Monitor Test:

If a regular electrocardiogram (ECG) does not give any clear idea about the heart rhythm, holter monitor test is performed. In this test, a sensor is fixed to the patient’s body to monitor the heart’s electrical activity continuously (usually for a period of 24 hours).

Cardiac Catheterisation:

It is a procedure in which, a catheter is passed into an artery or vein and guided to the heart. The procedure helps to check the blood pressure and the blood flow within the chambers of the heart. Any abnormal blockages in the arteries can also be visualised.

Myocardial Biopsy:

The biopsy involves removal of a small amount of tissue from the heart muscle for microscopic examination. It is performed along with cardiac catheterisation. The biopsy sample is then examined under microscope to look for cell changes suggestive of cardiomyopathy.

Genetic Testing:

It is mainly performed to understand the genetic basis by which the patient has inherited this condition.

Treatment of Cardiomyopathy:

Treatment of this condition depends on the age of the patient, the type of cardiomyopathy, the severity of symptoms and its associated complications.

Treatment for cardiomyopathy includes:

Medical Management:

  • Angiotensin-converting enzyme inhibitors and beta blockers like atenolol are used to lower blood pressure in the heart and also to slow the heart rate.
  • Antiarrhythmic drugs like quinidine are used to prevent arrhythmias.
  • Other drugs like calcium channel blockers, diuretics and anticoagulants may also be recommended for patients with cardiomyopathy.These drugs support the heart function and prevent heart failure.

Surgical Management:

The common types of surgeries are:

Septal Myectomy: It is a surgery, in which a small section of the thick septum, which bulges into the left ventricle, is removed. This improves the blood flow from the ventricle to the aorta.

Surgical implantation of devices:  Implantation of certain devices help to improve the function of the heart. They include:

  • Pacemaker: It is a small device placed under the skin in the upper chest. This device helps in regulating heart’s rate and rhythm.
  • Ventricular assist device: It is placed for a short period or long period, in patients who require a heart transplantation. This device aids in maintaining a regular blood flow through the heart.
  • Implantable cardioverter defibrillator: It is placed in the chest and is connected to the heart. This device detects the abnormal changes in the heart rhythm and signals the heart, to restore normal heartbeat.

Non-surgical Management:

Alcohol septal ablation: In this procedure, the doctor administers ethanol into the small artery, which supplies blood to the thickened cardiac muscle. This alcohol will kill the enlarged muscle tissue and shrinks it to the regular size. It also improves the blood flow through and out of the heart.

Prevention of Cardiomyopathy:

Prevention of cardiomyopathy is essential to avoid further life-threatening complications like a sudden cardiac arrest. Prevention of hereditary cardiomyopathies is not possible; however, the risk of acquiring other types of cardiomyopathies can be reduced by taking the following measures:

  • Control of high blood pressure and high cholesterol
  • Control of obesity
  • Regular physical activity like exercise and walking
  • Avoid stressful environment both at work and at home
  • Take a healthy diet

Cardiomyopathy is not fatal, at all the times. Early diagnosis and appropriate management help to reduce the risk of complications of cardiomyopathy.

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