Cardiomyopathy

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

When the heart muscle weakens, the amount of blood ejected with each heart beat declines. The type of heart failure is called systolic dysfunction.

 Patients may have symptoms due to reduced function of the heart such as congestion (swelling of the feet and ankles; fluid in the lungs) or fatigue (shortness of breath, less stamina). In some cases, the heart may pump blood out to the body in a normal manner but have problems with filling between each heart beat. This type of heart failure is called diastolic dysfunction

Specific types of cardiomyopathy may include:

  • alcoholic cardiomyopathy  

  • dilated cardiomyopathy  

  • hypertrophic cardiomyopathy/idiopathic cardiomyopathy  

  • ischemic cardiomyopathy  

  • peripartum cardiomyopathy  

  • restrictive cardiomyopathy  

Risk factors

Cardiomyopathy can be caused by viral infections, heart attacks, alcoholism, long–term, severe high blood pressure, metabolic diseases (diabetes, thyroid), nutritional deficiencies (particularly selenium, thiamine, and L–carnitine),  prior medical treatment  (cancer treatment, in particular doxarubicin), and end–stage kidney disease.

Symptoms

Patients with cardiomyopathy may present with one or several of the following symptoms:

  • abdominal swelling or enlargement

  • change in mental status

  • chest pain

  • cough

  • decreased alertness/difficulty concentrating

  • decreasing ability to tolerate physical exertion

  • dizziness

  • fainting

  • fatigue

  • high blood pressure  

  • light–headedness

  • loss of appetite

  • low amount of urine during daytime

  • need to urinate at night

  • palpitations

  • shortness of breath

  • swelling of legs, ankles, or other portion of the body

Diagnostic Tools

Many tests are used to diagnose cardiomyopathy. Usually, more than one test is done before a definitive diagnosis can be made. These tests may include: 

  • physical examination and patient history   

  • blood tests (b–type naturetic peptide)

  • ECG 

  • chest X–ray  

  • echocardiogram 

  • cardiac catheterization and coronary angiography  

  • chest CT scan  

  • chest MRI  

  • myocardial biopsy  

Treatment Options

Both medication and surgery may be considered for patients with cardiomyopathy. Medications for cardiomyopathy may include:

  • ACE inhibitors  

  • beta blockers  

  • diuretics  

  • positive inotropic agents chemicals which help the heart contract.

  • Other vasodilators (nitrates) 

If medications alone do not work, physicians may consider the following treatment options:

  • biventricular pacemaker/defibrillator (cardiac resynchronization therapy): a device which is placed in the heart chambers to help coordinate the pumping action of both sides of the heart.

  • pacemakers with defibrillation functions

In severe cases, surgeons may also consider the following procedures to sustain life until a transplant donor becomes available:

  • dynamic cardiomyoplasty: a procedure used for heart failure, where muscle from the chest wall is wrapped around the heart to help it contract

  • heart transplant  

  • left ventricular assist device (LVAD): a left ventricular assist device (LVAD or VAD) placed inside the chest to help the heart pump blood

Diagrams:
Click images to enlarge

Normal Heart
Normal Heart 

 

 

Systolic Failure
Heart with Systolic Heart Failure 

 

Diastolic Failure
Heart with Diastolic Heart Failure

 

Resynchronization Therapy
Cardiac Resynchronization Therapy

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