Cardiomyopathy

What is Cardiomyopathy, its types, and treatment?

Our heart is a pump in which contracts and blood are pumped throughout the body. The heart is made up of specialized muscles for this function. Cardiomyopathy as the name indicates is a disease of heart muscles so the heart is unable to do its functions which had a variety of consequences ranging from mild breathlessness to heart failure or sudden death.

Cardiomyopathy is mainly of four types:

1. Dilated Cardiomyopathy: Most common form, where heart muscles become weak and not able to pump the blood effectively. The heart muscles become thinner and chambers of the heart expand causing a condition also called dilated heart.
2. Hypertrophic Cardiomyopathy: This is a genetic condition. It occurs when the walls of the heart get thickened and prevent the flow of blood through this natural pump. This is one of the causes of sudden death in young persons.
3. Arrhythmogenic Right Ventricular Dysplasia: This is a rare form of cardiomyopathy.  It occurs when fat and fibrous tissues replace muscle in the right ventricle of the heart.
4. Restrictive Cardiomyopathy: This is the least common form of the disease. The cause is the stiffening of the ventricles, so it does not allow them to receive blood to fill adequately before pumping.

Other types of cardiomyopathy include:

1. Ischemic Cardiomyopathy: It is a form of dilated cardiomyopathy which occurs due to coronary artery disease in which blood vessels supplying blood to the heart, become narrow. The heart becomes weak and dilated.
2. Non-compaction Cardiomyopathy: When the left ventricle has trabeculations, projections of muscle inside the ventricle.
3. Peripartum Cardiomyopathy: Another form of the disease can occur during or after pregnancy. This is a form of dilated cardiomyopathy and can be fatal.
4. Alcoholic Cardiomyopathy: Is caused due to excess alcoholism causing an enlargement of the heart.
5. Takotsubo Cardiomyopathy: Or broken heart syndrome, happens when extreme stress leads to heart muscle failure. Though rare, this condition is more common in post-menopausal women.
6. Drug-induced Cardiomyopathy: Some drugs especially few anti-cancer drugs are known to cause.

Symptoms: Patients usually have breathlessness initially on exertion and then may occur at rest, swollen feet, or generalized swelling all over the body, fatigue, Palpitation, and chest pain. Some conditions are known to cause sudden death.

Investigations: ECG, 2D echo are useful in most cases for making the diagnosis. Depending on conditions, x-ray chest, coronary angiography, cardiac catheter studies, cardiac MRI, and blood tests are required. If someone has a history of sudden death in young age family members then screening of first degree relatives should be done.

Treatment: Thorough history, examination, and investigation will decide the extent of damage due to cardiomyopathy. Usually, all the conditions require medical therapy whenever possible:

1. Medications are given to prevent water retention, keep the heart beating normally, prevent blood clots and reduce inflammation, and improve the dilatation.
2. It is advised to maintain a healthy weight, eat a heart-healthy diet, manage stress, quit smoking, and excess alcohol.
3. Regular bouts of low-intensity exercise should be done depending on the condition.
4. Pacemakers and defibrillators can be implanted.
5. Surgery like a heart transplant can be done as a last resort.

Most of the cardiomyopathy forms can’t be cured but the good news is that some newer medications and therapies are available which make the person live a better quality of life and sometimes reverses the disease process and make the heart function normally. If diagnosed in time and treated, a lot of complications can be prevented and some extra years to life are added.

Dr. Sajal Gupta, Consultant – Cardiology, Dharamshila Narayana Superspeciality Hospital, Delhi