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Cardiomyopathy


What is cardiomyopathy?

Cardiomyopathy is a disease of the heart muscle that decreases the blood’s ability to pump blood. Over time, the heart muscle enlarges, becomes thick or rigid, and grows weaker. As a result, the heart has a harder time maintaining a normal electrical rhythm and pumping blood throughout the body. This can lead to irregular heartbeats (arrhythmias) or heart failure.

Though the cause of cardiomyopathy isn’t always know, some people inherit the gene for the disease from their parents, or develop it as a result of damage to the heart, such as from a heart attack. The disease can affect people of all ages, though certain types of cardiomyopathy are more likely to affect specific age groups.

There are three main types of cardiomyopathy:

  • dilated cardiomyopathy, which occurs when the left ventricle—the heart’s main pumping chamber—enlarges and is unable to pump enough blood to meet the body’s needs, sometimes leading to heart failure. This is the most common type of cardiomyopathy, typically affecting people aged 20 to 60, and usually more men than women; it can be caused by a number of factors, including viral infection of the heart muscle, diabetes or thyroid disease, or alcohol and drug abuse.
  • hypertrophic cardiomyopathy, which occurs when the walls of the left ventricle thicken so that it holds less blood, then stiffens so that it is unable to relax and fill with blood. This can disrupt the heart’s electrical signals, which can lead to arrhythmias, and in some cases, sudden death. Hypertrophic cardiomyopathy is common and can affect men and women of all ages. It can be inherited or caused by high blood pressure or aging, but for some, the cause may be unknown.
  • restrictive cardiomyopathy, which occurs when the ventricles become stiff and rigid so that they cannot relax normally and fill with blood, and the atria (the top chambers of the heart) become large, reducing blood flow in the heart, which leads to heart failure in most cases. It is the least common type of cardiomyopathy, and tends to mostly affect older adults. Its cause is unknown.

What are the symptoms of cardiomyopathy?

People may have different symptoms, depending on the type of cardiomyopathy they have.

Dilated cardiomyopathy
Many people with dilated cardiomyopathy experience minor or no symptoms. Others might develop symptoms that progress as their heart function gets worse. Common symptoms include:

  • shortness of breath (particularly when active)
  • problems breathing when lying down
  • fatigue (feeling overly tired)
  • swelling of feet and legs
  • weight gain
  • cough and congestion
  • palpitations (the feeling of your heart skipping a beat, thumping or fluttering in your chest, or beating too hard or fast)
  • dizziness, light-headedness, or fainting

Hypertrophic cardiomyopathy
Some people with hypertrophic cardiomyopathy may never have any symptoms, while others may have severe symptoms and complications including:

  • fainting or passing out
  • chest pain
  • shortness of breath (particularly when active)
  • palpitations

Restrictive cardiomyopathy
Common symptoms associated with restrictive cardiomyopathy include:

  • shortness of breath (at first with exercise, but it also occurs at rest over time)
  • fatigue
  • inability to exercise
  • swelling of the legs and feet
  • weight gain
  • nausea, bloating, and poor appetite
  • palpitations

How is cardiomyopathy diagnosed?

The diagnosis of cardiomyopathy begins with a discussion with your doctor about your medical history and the symptoms you have been having and how long you’ve had them. Your doctor will also ask if anyone else in your family has had cardiomyopathy, heart failure, or sudden cardiac arrest.

Next, your doctor will want to perform a physical exam. During the exam, the doctor will listen to your heart and lungs with a stethoscope for sounds that might point to a certain type of cardiomyopathy. The doctor will also examine your ankles, feet, legs, abdomen, or veins in your neck for swelling, which could indicate fluid retention, a sign of heart failure.

In addition, the doctor may want you to have certain tests done to help with the diagnosis. These tests may include:

  • blood tests that provide information about your heart
  • chest x-ray to see whether your heart is enlarged or if fluid is building up in your lungs
  • electrocardiogram (EKG or ECG), which is a simple, painless test performed in the doctor’s office that shows how well your heart is working and to detect any problems
  • exercise stress test, during which you walk on a trend mill or ride a stationary bike to make your heart work hard and beat fast while heart tests are performed

Your doctor may also want you to have one or more medical procedures to confirm the diagnosis, including:

  • cardiac catherterization, during which a long, thin, flexible tube called a catheter is inserted into a blood vessel in the arm, upper thigh, neck, then threaded into the heart. There, it can measure pressures in the heart chamber to gauge its pumping ability. The procedure is typically performed in a hospital while you’re awake and with minimal pain.
  • coronary angiography, which involves using an iodine dye and x-rays to show the inside of your coronary arteries so that the doctor can see the flow of blood through your heart and blood vessels; this procedure is often done with cardiac catheterization.
  • myocardial biopsy, which is the removal of a tissue sample from the heart during cardiac catherization to examine for signs of changes in cells. This can help with determining the cause of some types of cardiomyopathy.

While your doctor may detect signs of cardiomyopathy, a cardiologist—a doctor who specializes in the diagnosis and treatment of heart problems—will diagnose your condition.

How is cardiomyopathy treated?

People with cardiomyopathy who have no signs or symptoms may not need any treatment. But for people who do have signs or symptoms, treatment is needed. The kind of treatment they need depends on a number of factors, including the type of cardiomyopathy they have, how severe their symptoms are, their age, and their overall health.

The main goals of treatment for cardiomyopathy are:

  • managing the conditions that are causing the disease
  • improving the function of the heart and reducing symptoms
  • keeping the disease from getting worse

Depending on the type of cardiomyopathy you have and the condition that is causing it, your treatment options may include lifestyle changes, medications, and surgery. Your doctor will tell you which options are best for you.

Lifestyle changes

Changes to your lifestyle can have a positive impact on reducing symptoms of a condition that may be causing your cardiomyopathy. Some changes that your doctor may recommend are:

  • eating a healthy diet (such as foods that are low in fat, sodium, and sugar)
  • quitting smoking
  • avoiding alcohol and illegal drugs
  • reducing stress
  • getting enough rest
  • treating other conditions (such as high blood pressure or diabetes)

Exercise is also important, but you should talk to your doctor before you start. He or she will tell you the kinds and level of physical activity that is safe for you.

Medications

For people who have cardiomyopathy, the following medications are used to improve the function of the heart, treat symptoms, and prevent complications:

  • ACE inhibitors to reduce the risk of heart attack and death due to coronary disease in people who have shown evidence of coronary artery disease
  • aldosterone blockers for balancing electrolytes in the body
  • angiotensin II receptor blockers to help relax blood vessels, which lowers blood pressure and makes it easier for the heart to pump blood
  • antiarrhythmics to treat and prevent irregular heartbeats
  • beta-blockers to slow down the heart rate and reduce blood pressure, which then reduces the heart’s demand for oxygen; they also reduce the risk of heart attacks and sudden death
  • blood thinners (aspirin, anti-coagulants) to lower the risk of blood clots in the heart or blood vessels
  • calcium channel blockers to relax blood vessels and increase the supply of blood and oxygen to the heart; reduce the heart's workload
  • corticosteroids for reducing inflammation
  • digoxin to increase the strength of heartbeats
  • diuretics to remove excess fluids and sodium in the body
  • vasodilators (nitrates) to relax or widen blood vessels to allow more blood flow to the heart and reduce strain on the heart

Surgery

There are also different types of surgery that can be performed to treat cardiomyopathy, such as surgically implanted devices, septal myectomy, and heart transplant.

  • Surgically implanted devices are placed under the skin in the chest or abdomen with wires leading to the heart; these devices include:
    • pacemaker – which is a small electronic device that monitors the heart’s electrical activity; if it detects an abnormal rhythm, it sends a pulse to the heart to return the heart to its normal rate
    • cardiac resynchronization therapy (CRT) device – which coordinates contractions between the left and right ventricles of the heart
    • implantable cardioverter defibrillator (ICD) – which sends a shock to the heart when it senses fast arrhythmias
    • left ventricular assist device (LVAD) – that works with the heart to pump blood to the rest of the body in people who are waiting for a heart transplant
  • Septal myectomy (open heart surgery) is used for people who have severe symptoms of hypertrophic cardiomyopathy. During surgery, a section of a thickened wall obstructing the left ventricle is removed to improve blood flow through the heart. This surgery is usually performed on younger patients whose medications aren’t working.
  • Heart transplants are reserved for people who have end-stage heart failure, which means their condition has gotten so severe, there are no other treatment options available. This surgery replaces the patient’s diseased heart with the healthy heart from someone who has died.

Advanced Cardiovascular Care at Jeanes Hospital

If you’re experiencing symptoms of cardiomyopathy, the highly-experienced cardiologists at the Temple Heart & Vascular Institute at Jeanes Hospital are ready to assist in the diagnosis and treatment of your condition. From patient consultation to a full range of diagnostic tests and surgical procedures, our Temple doctors are prepared to help you understand and manage all aspects of your cardiomyopathy.

The Temple cardiologists at Jeanes Hospital evaluate hundreds of patients every year, managing a wide range of serious cardiovascular conditions. After careful evaluation, they can develop and oversee a treatment plan tailored to meet your specific needs.

Procedures performed here for the diagnosis and treatment of cardiomyopathy and its related conditions include:

  • Diagnostic and coronary angiography
  • Right/left heart catheterization for pressure/flow monitoring or cardiac biopsy
  • Insertion of pacemaker and cardiac defibrillator implants
  • Synchronized biventricular pacers for heart failure
  • Complex coronary interventions
  • Surgical treatment of cardiac arrhythmia
  • Heart value repair and replacement
  • Surgical treatment of cardiac arrhythmia

This is the level and quality of care you would expect to find downtown or in another city. Yet, it's available right here, in your own community.

To schedule an appointment with a cardiologist at the Temple Heart & Vascular Institute at Jeanes Hospital, click here or call 215-728-CARE (2273).

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