Cardiomyopathy

CausesIn many cases, the exact cause is not known. Possible causes include: Dilated The cause of the initial damage is often not found, but may include: Ischemic heart disease with decreased blood flow to the heart Infections, usually viral Chronic exposure to toxins, including alcohol and some chemotherapy drugs A rare complication of pregnancy or childbirth (probably immune-related) Rarely, other illnesses, including rheumatoid arthritis , diabetes, or thyroid disease Hypertrophic Causes may include: Inherited: sometimes present at birth but often developing in teensAging: associated with hypertension Restrictive This is usually related to another condition, such as: Amyloidosis protein fibers collect in the heart muscle Sarcoidosis small inflammatory masses (granulomas) form in many organs Hemochromatosis too much iron in the body Risk Factors A risk factor is something that increases your chance of getting a disease or condition. Family members with cardiomyopathyAlcoholismObesityDiabetesHypertensionCoronary artery diseaseCertain drugs Symptoms Symptoms vary, depending on the type of cardiomyopathy and its severity. Patients with hypertrophic cardiomyopathy often do not notice any symptoms. Sudden cardiac death may be the first indication of the condition. In dilated cardiomyopathy, it may take years for symptoms to develop. Blood clots may form due to the abnormal pooling of blood in the heart. If a clot moves to another part of the body ( embolism ), symptoms associated with that organ (the brain, for example) may be the first sign of the heart disease.

Cardiomyopathy ultimately leads to heart failure and the following symptoms: FatigueWeaknessShortness of breath, often worse when lying down or with exertionCoughSwelling in feet or legsChest painIrregular heart rhythm Diagnosis The doctor will: Ask about your symptoms and medical historyPerform a physical examListen to your heart with a stethoscope (Cardiomyopathies often produce heart murmurs and other abnormal heart sounds.) Tests may include: Chest x-ray to look for heart enlargement Electrocardiogram a test that records the heart's activity by measuring electrical currents through the heart muscle Echocardiogram a test that uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart Blood teststo check for damage to the heart and other organs, and possibly the underlying cause(s) of the cardiomyopathyCardiac catheterization a tube-like instrument inserted into the heart through a vein or artery (usually in the arm or leg) to detect problems with the heart and its blood supply Heart biopsy removal of a sample of heart tissue for testing Treatment When heart failure is due to blockages in the coronary arteries, treatment directed at relieving these blockages through angioplasty , stent placement , or coronary artery bypass surgery may lead to improvements in heart function and symptoms. For certain genetic causes, other treatments may also lead to improvements in function. For many patients, however, treatment is aimed at relieving symptoms and prevent further damage.

Lifestyle Modification Changes aim to eliminate anything that contributes to the disease or worsens symptoms: Avoid alcohol.If you are overweight, lose weight.Eat a low-fat diet to minimize the risk and extent of coronary artery disease.Limit salt intake to decrease fluid retention.Follow your doctor's advice for exercise. You may need to limit physical activity. Medications Medications may include: Diureticsto eliminate extra fluidACE inhibitorsto help relax blood vessels, lower blood pressure, and decrease the heart's workloadDigitalisto slow and regulate the heart rate, and modestly increase its force of contractionsCalcium channel blockersto lower blood pressure and relax the heartBeta blockersto slow the heart and limit disease progressionAnti-arrhythmia agentsto prevent irregular heart rhythmsImmune system suppressantsincluding steroids (depending on underlying cause) Surgery Surgical options include: A pacemaker may be implanted to improve the heart rate and pattern. For patients with hypertrophic disease, doctors may remove part of the thickened wall separating the heart's chambers. Surgery may be needed to replace a heart valve. A heart transplant may be possible for otherwise healthy patients who do not respond to medical treatment. Candidates often wait a long time for a new heart. Those waiting may temporarily receive a ventricular assist device, which is a mechanical pump that assumes some or most of the heart's pumping function. PreventionAggressively treating hypertension, coronary artery diseases, and their risk factors is the best way to prevent most cases of cardiomyopathy. Other, less common causes, however, are not preventable. People with a family history of the disease should ask the doctor about screening tests, especially before starting an intense exercise program.

RESOURCES: American Heart Associationhttp://www.americanheart.org The Cardiomyopathy Associationhttp://www.cardiomyopathy.org/homepage.htm CANADIAN RESOURCES: Canadian Cardiovascular Societyhttp://www.ccs.ca/home/index_e.aspx Canadian Family Physicianhttp://www.cfpc.ca/cfp/ References: Braunwald E, Zipes DP, Libby P, et al. Heart Disease: A Textbook of Cardiovascular Medicine . 6th ed. Philadelphia, PA: WB Saunders Company; 2001. Cecil RL, Goldman L, Bennett JC. Cecil Textbook of Medicine . 21st ed. Philadelphia, PA: WB Saunders Company; 2000. Dambro MR. Griffith's 5-Minute Clinical Consult . Philadelphia, PA: Lippincott Williams & Wilkins; 2001. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/ . Accessed October 13, 2005. Primary Care Medicine . 4th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2000. Last reviewed December 2007 by J. Peter Oettgen, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.