Cardiomyopathy

What is Cardiomyopathy?

Cardiomyopathy is a condition when the heart muscles become big, think or rigid. Literally it is a heart muscle disease. As cardiomyopathy becomes worse the heart becomes weak. People with cardiomyopathy are often at risk of irregular heartbeat, heart failure and sudden cardiac death. The weakening of the heart can also cause heart valve problems and other complications.

Types of Cardiomyopathy

There are main four types of cardiomyopathy, and other types of cardiomyopathy sometimes are referred to as unclassified cardiomyopathy. The main four are:

• Dilated cardiomyopathy
• Hypertrophic cardiomyopathy
• Restrictive cardiomyopathy
• Arrhythmogenic right ventricular dysplasia (ARVD)

Dilated Cardiomyopathy

Dilated Cardiomyopathy is the most common and mostly occurs in adults aged 20 to 60. Men tend to have this type of cardiomyopathy than women.

In dilated cardiomyopathy the lower (ventricles) and upper(atria) chambers are been affected. It often starts in the left ventricle where the heart muscle start to stretch and become thinner (dilate) causing the inside chamber to become big.Eventually the problem then spreads to right ventricle and then to atria. Due to dilation of heart chambers the heart muscle won’t be able to contract normally, as a result heart cannot pump acquaint amount of blood and heart start to become weak. The weak heart can lead to cause heart failure, arrhythmias, heart valve problems and blood clots in heart causing heart attack.

Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy is also very common type of cardiomyopathy and can affect any aged people. In this type, both men and women are equally in risk. In young people such as young athletes, hypertrophic cardiomyopathy is the common cause of sudden cardiac arrest.

Hypertrophic cardiomyopathy occurs if the heart muscle cells enlarge causing the ventricles’ wall (usually left one) to become thick. Ventricle often remains normal even though the walls have become thick but the thickening may block the blood flow out from the ventricles. This kind of condition is called obstructive hypertrophic cardiomyopathy. However in some cases the thickening of heart muscles doesn’t affect the blood flow out of the ventricle. This kind of condition is called nonobstructive hypertrophic cardiomyopathy.

Also in some cases the septum becomes thick and bulges into the left ventricle which can also block the blood flowout from the ventricles. Hypertrophic cardiomyopathy can also affect the mitral valve which can cause blood to leak backward through the valve.

In both obstructive and nonobstructivehypertrophic cardiomyopathy, the inside of left ventricle becomes small due to thickening of the muscle as a result the ventricle can contain less amount of blood. Also due to thickening, the walls of ventricles can be stiff which can cause less flexibility in ventricleto expand as the ventricles fill with blood.

These changes can raise blood pressure and also due to the changes occurred in the cells of damaged heart muscles the heart’s electrical signal can be disrupted.

Often hypertrophic cardiomyopathy doesn’t have any signs and symptoms hence go undiagnosed. In some cases this condition can cause symptoms like shortness of breath and life threatening abnormal heart rhythms. Beside that the disease doesn’t affect thelives with significant problems.

Restrictive Cardiomyopathy

Restrictive Cardiomyopathy is one of the rarest forms of cardiomyopathy and tends to affect mostly older adults. In restrictive cardiomyopathy the ventricles becomes abnormally rigid and lack the flexibility to expand as the ventricles fill with blood. This can cause atria to become enlarge and eventually the blood flow to the heart is gradually reduced.

This can lead to problems such as heart failure or arrhythmias.

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is also known as Arrhythmogenic Right Ventricular Dysplasia(ARVD) and is a rare form of cardiomyopathy. ARVC/D is an inherited heart disease. It is an important cause of ventricular arrhythmias in children and young adults. It is seen predominantly in males, and 30-50% of cases have a familial distribution.

In ARVC/D the heart muscle of the right ventricle dies and is replaced by fat and/or fibrous tissue causing right ventricle to dilate and contract poorly and can disrupt the heart’s electrical signals. This can lead to problems such as arrhythmias.It can cause sudden cardiac arrest or death in young athletes

Causes of Cardiomyopathy

In most of the cases the cause of the cardiomyopathy is not known.  Cardiomyopathy can be acquired or inherited. Acquired meansthe disease is developed due to other diseases, factors or conditions. Inherited means the diseased is developed genetically.Possible causes of cardiomyopathy include:

• Uncontrolled high blood pressure
• Damage to heart tissue due to previous heart attack
• Heart valve problems
• Tachycardia(chronic heart rate)
• Diabetes
• Thyroid disease
• Deficiencies in essential nutrition such as vitamins or minerals
• Certain viral infections causing injury to heart muscles
• Hemochromatosis (iron buildup in heart muscle)
• Pregnancy
• Sevier alcoholism
• Drug abuse
• Certain chemotherapy medications
• Genetic conditions

Symptoms of Cardiomyopathy

In some cases people who have developed cardiomyopathy have no signs or symptoms at all and in some cases people don’t have signs or symptoms during the early stages of the disease. But as cardiomyopathy advances and the heart weaken, signs and symptoms usually appears which may include:

• Shortness of breath with physical exertion or even at rest
• Fatigue
• Swelling in the ankles, feet, legs and veins in the neck
• Bloating of the abdomen due to fluid buildup
• Irregular heartbeats that feels rapid, pounding or fluttering
• Dizziness, lightheadedness and fainting during physical activity
• Chest pain, especially after physical exertion or heavy meals
• Heart murmurs

Who is at the risk of Cardiomyopathy?

People of all ages and gender can have cardiomyopathy. However, certain type of cardiomyopathy ismore common in certain age groups.

Major Risk Factors

Major risk factors include:

• Having a family history of cardiomyopathy, heart failure, or sudden cardiac arrest
• Having certain disease or health condition that can cause cardiomyopathy which includes:
  • Coronary heart disease
  • Heart attack
  • Myocarditis(viral infection that inflames the heart muscle)
• Having uncontrolled high blood pressure for long term
• Having diabetes
• Having sever obesity
• Havingdiseases that can damage the heart which includes:
  • Hemochromatosis
  • Sarcoidosis
  • Amyloidosis
• Having sever alcoholism for a long time

Diagnosis of Cardiomyopathy

The doctor will diagnose cardiomyopathy based on the medical and family history, a physical exam, and the results from tests and procedures.

Medical and Family Histories

The doctor may ask series of question regarding the symptoms of cardiomyopathy and how long it had been there.  Also may ask if the patience use alcohol for long time.

Further the doctor may ask regarding the background of patience’s family if any of the sibling or parents had a history of cardiomyopathy, heart failure, or sudden cardiac arrest.

Physical Examination

The doctor may listen to the sound of heart and lungs. For example the loudness, timing and location of heart murmur may suggest obstructive hypertrophic cardiomyopathy. A "crackling" sound in the lungs may be a sign of heart failure. To confirm the heart failure the doctor also may check for other signs of heart failure such asthe ankles, feet, legs, abdomen, or veins in the neck for swelling which suggests fluid buildup.

Tests and Procedures

Some of the tests and procedures will be prescribed.

Laboratory Test

• Blood tests

ImagingTests

• Chest X-ray
• Holter and Event Monitors
• Electrocardiogram (EKG/ECG)
• Echocardiography (ECHO)
• Stress test

Invasive Testing

• Cardiac catheterization
• Coronary angiography
• Myocardial biopsy

Genetic Testing

Treatments of Cardiomyopathy

Treatment of cardiomyopathy may include lifestyle changes, medicines, implanted devices to correct arrhythmias (irregular heartbeats), and surgical and nonsurgical procedure.

Lifestyle Changes

There are some lifestyle factors which can cause cardiomyopathy. Changing certain habitscan help reduce symptoms such as:

• Having healthy diet
• Be physically activity
• Quitting smoking or tobacco using 
• Losing weight
• Reducing alcoholism
• Avoiding use of illegal drugs
• Reducing stress
• Controlling high blood pressure
• Managing diabetes

Medicines

There are certain types of medicine used such as:

• ACE inhibitors
• AngiotensinII receptor blockers
• Betablockers
• Calciumchannel blockers
• Digoxin
• Antiarrhythmic
• Aldosterone blockers
• Diuretics “water pills”
• Anticoagulants “blood thinners”
• Corticosteroids

These medicines used are for:

• To lower the blood pressure
• To slow down the heart rate
• To keeps the heart beating in a normal rhythm
• To balance the electrolytes in the body
• To remove the excess fluid and sodium from the body
• To prevent blood clots from forming
• To reduce inflammation

Medical Procedure

• Alcohol septal ablation

SurgicalProcedures

• Septalmyectomy (open heart surgery)
• Surgically implanted devices
  • Pacemaker
  • Cardiacresynchronization therapy (CRT) device
  • Leftventricular assist device
  • Implantable cardioverter defibrillator
• Heart transplant

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