CARDIOMYOPATHY

INTRODUCTION
Cardiomyopathy is a group of diseases that affect the heart muscle. Early on there may be few
or no symptoms. Others may have shortness of breath, feel tired, or have swelling of the
legs due to heart failure. An irregular heart beat may occur as well as fainting. Those affected
are at an increased risk sudden cardiac death.
Definition
Cardiomyopathy is a chronic disease of the heart muscle (myocardium), in whichthe muscle i
s abnormally enlarged, thickened, and/or stiffened. The weakenedheart muscle loses the abilit
y to pump blood effectively, resulting in irregularheartbeats (arrhythmias) and possibly even
heart failure.
According to free medical dictionary by Farlex
INCIDENCE
In 2013 cardiomyopathy and myocarditis affected 7.9 million people. Hypertrophic
cardiomyopathy affects about 1 in 500 people while dilated cardiomyopathy affects 1 in
2,500.They resulted in 443,000 deaths up from 294,000 in 1990.Arrhythmogenic right
ventricular dysplasia is more common in young people.
TYPES OF CARDIOMYPPATHY :- The types of cardiomyopathy include:

Hypertrophic cardiomyopathy

Dilated cardiomyopathy

Restrictive cardiomyopathy

Arrhythmogenic right ventricular cardiomyopathy

Unclassified cardiomyopathy

1. Hypertrophic Cardiomyopathy :- Hypertrophic cardiomyopathy is very common

and can affect people of any age. Hypertrophic cardiomyopathy affects men and
women equally, and about 1 out of every 500 people has the disease. Hypertrophic
cardiomyopathy happens when the heart muscle enlarges and thickens without an
obvious cause.
2. Dilated Cardiomyopathy :- Dilated cardiomyopathy develops when the ventricles
enlarge and weaken. The condition usually starts in the left ventricle and over time
can affect the right ventricle. The weakened chambers of the heart dont pump
effectively, causing the heart muscle to work harder.
3. Restrictive Cardiomyopathy :- Restrictive cardiomyopathy develops when the
ventricles become stiff and rigid but the walls of the heart do not thicken. As a result,
the ventricles do not relax and dont fill with the normal blood volume.
4. Arrhythmogenic Right Ventricular Dysplasia :- Arrhythmogenic right ventricular
dysplasia is a rare type of cardiomyopathy that occurs when the muscle tissue in the
right ventricle is replaced with fatty or fibrous tissue. This can lead to disruptions in
the hearts electrical signals and causes arrhythmias
5. Unclassified Cardiomyopathy :- Other types of cardiomyopathy are grouped into
this category and can include:
Left ventricular noncompaction happens when the left ventricle has
trabeculations, projections of muscle inside the ventricle.

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.

CAUSES :- Cardiomyopathy can be acquired or inherited. Acquired means you arent

born with the disease, but you develop it due to another disease, condition, or factor.
Inherited means your parents passed the gene for the disease on to you.
1. Hypertrophic Cardiomyopathy :- Hypertrophic cardiomyopathy usually is
inherited. Its caused by a mutation or change in some of the genes in heart muscle
proteins.
2. Dilated Cardiomyopathy:- The cause of dilated cardiomyopathy often isnt known.
About one-third of the people who have dilated cardiomyopathy inherit it from their
parents.
Certain diseases, conditions, and substances also can cause the disease,
such as: Alcohol, Certain toxins, such as poisons and heavy metals, Coronary heart
disease, heart attack, high blood pressure, diabetes, thyroid disease, viral hepatitis,
and HIV
3. Restrictive Cardiomyopathy
Certain diseases, conditions, and factors can cause restrictive cardiomyopathy,
including:Amyloidosis: A disease in which abnormal proteins build up in the
bodys organs, including the heart,
Connective tissue disorders
Hemochromatosis: A disease in which too much iron builds up in the body. The
extra iron is toxic to the body and can damage the organs, including the heart.
Sarcoidosis: A disease that causes inflammation and can affect various organs in
the body. Researchers believe that an abnormal immune response may cause
sarcoidosis. This abnormal response causes tiny lumps of cells to form in the
bodys organs, including the heart.
4. Arrhythmogenic Right Ventricular Dysplasia :- Researchers think that
arrhythmogenic right ventricular dysplasia is an inherited disease.
MAJOR RISK FACTORS :- Certain diseases, conditions, or factors can raise your risk for
cardiomyopathy. Major risk factors include:

A family history of cardiomyopathy, heart failure, or sudden cardiac arrest (SCA)

A disease or condition that can lead to cardiomyopathy, such as coronary heart
disease, heart attack, or a viral infection that inflames the heart muscle
Diabetes or other metabolic diseases, or severe obesity
Diseases that can damage the heart, such as hemochromatosis, sarcoidosis, or
amyloidosis
Long-term alcoholism
Long-term high blood pressure

PATHOPHYSIOLOGY :The heart muscle becomes enlarged, thick, or rigid.

The muscle tissue in the heart is replaced with scar tissue.
As cardiomyopathy worsens, the heart becomes weaker.
It's less able to pump blood through the body and maintain a normal electrical rhythm.

This can lead to heart failure or irregular heartbeats called arrhythmias.

It leads heart failure can cause fluid to build up in the lungs, ankles, feet, legs, or abdomen.
The weakening of the heart also can cause other complications, such as heart valve problems.
CLINICAL MANIFISTATION:- As cardiomyopathy worsens and the heart weakens,
signs and symptoms of heart failure usually occur. These signs and symptoms include:

Shortness of breath or trouble breathing, especially with physical exertion

Fatigue (tiredness)
Swelling in the ankles, feet, legs, abdomen, and veins in the neck
Other signs and symptoms may include dizziness; light-headedness; fainting during
physical activity; arrhythmias (irregular heartbeats); chest pain, especially after
physical exertion or heavy meals; and heart murmurs. (Heart murmurs are extra or
unusual sounds heard during a heartbeat.)

DIAGNOSTIC EVALUATION:1. Medical and Family History :- doctor will want to learn about your
medical history. He or she will want to know what signs and
symptoms you have and how long you've had them.doctor also will
want to know whether anyone in your family has had
cardiomyopathy, heart failure, or sudden cardiac arrest.
2. Physical Exam :- The loudness, timing, and location of a heart
murmur may suggest obstructive hypertrophic cardiomyopathy. A
"crackling" sound in the lungs may be a sign of heart failure. (Heart
failure often develops in the later stages of cardiomyopathy
3. Blood Tests :- Blood tests give your doctor information about your
heart and help rule out other conditions.
4. Chest X Ray :- A chest x ray takes pictures of the organs and
structures inside chest, such as heart, lungs, and blood vessels. This
test can show whether heart is enlarged. A chest x ray also can
show whether fluid is building up in lungs.
5. EKG (Electrocardiogram) :- An EKG is a simple test that records the
heart's electrical activity. The test shows how fast the heart is
beating and its rhythm (steady or irregular). An EKG also records the
strength and timing of electrical signals as they pass through each
part of the heart. This test is used to detect and study many heart
problems, such as heart attacks, arrhythmias (irregular heartbeats),
and heart failure. EKG results also can suggest other disorders that
affect heart function.
6. Holter and Event Monitors :- Holter and event monitors are small,
portable devices. They record your heart's electrical activity while
you do your normal daily activities. A Holter monitor records the
heart's electrical activity for a full 24- or 48-hour period.

7. Echocardiography :- (echo) is a test that uses sound waves to create

a moving picture of your heart. The picture shows how well your
heart is working and its size and shape.
8. Stress Test :- Some heart problems are easier to diagnose when
your heart is working hard and beating fast. During stress testing,
you exercise (or are given medicine if you're unable to exercise) to
make your heart work hard and beat fast while heart tests are done.
9. Cardiac Catheterization : During cardiac catheterization, a long, thin,
flexible tube called a catheter is put into a blood vessel in your arm,
groin (upper thigh), or neck and threaded to your heart. This allows
your doctor to study the inside of your arteries for blockages.
10.
Coronary Angiography :- This procedure often is done with
cardiac catheterization. During the procedure, dye that can be seen
on an x ray is injected into your coronary arteries. The dye lets your
doctor study blood flow through your heart and blood vessels.
11.
Myocardial Biopsy :- For this procedure, doctor removes a
piece of heart muscle. This can be done during cardiac
catheterization. The heart muscle is studied under a microscope to
see whether changes in cells have occurred. These changes may
suggest cardiomyopathy.

MANAGEMENT:- The main goals of treating cardiomyopathy include:

Controlling signs and symptoms so that you can live as normally as possible

Managing any conditions that cause or contribute to the disease

Reducing complications and the risk of sudden cardiac arrest

Stopping the disease from getting worse

1. Heart-Healthy Lifestyle Change :- doctor may suggest lifestyle changes to
manage a condition thats causing your cardiomyopathy including:
Heart-healthy eating
Aiming for a healthy weight
Managing stress
Physical activity
Quitting smoking
Medicines
Balance electrolytes in your body:- Electrolytes are minerals that help maintain
fluid levels and acid-base balance in the body. They also help muscle and nerve
tissues work properly. Abnormal electrolyte levels may be a sign of dehydration
(lack of fluid in your body), heart failure, high blood pressure, or other disorders.
Aldosterone blockers are an example of a medicine used to balance electrolytes.

 Keep your heart beating with a normal rhythm. These medicines, called
antiarrhythmics, help prevent arrhythmias.
Lower your blood pressure. ACE inhibitors, angiotensin II receptor blockers,
beta blockers, and calcium channel blockers are examples of medicines that lower
blood pressure.
Prevent blood clots from forming. Anticoagulants, or blood thinners, are an
example of a medicine that prevents blood clots. Blood thinners often are used to
prevent blood clots from forming in people who have dilated cardiomyopathy.
Reduce inflammation. Corticosteroids are an example of a medicine used to
reduce inflammation.
Remove excess sodium from your body. Diuretics, or water pills, are an example
of medicines that help remove excess sodium from the body, which reduces the
amount of fluid in your blood.
Slow your heart rate. Beta blockers, calcium channel blockers, and digoxin are
examples of medicines that slow the heart rate. Beta blockers and calcium channel
blockers also are used to lower blood pressure.
Surgery and Implanted Devices

Septal Myectomy :- Septal myectomy is open-heart surgery and is used to treat people
who have hypertrophic cardiomyopathy and severe symptoms. This surgery generally is
used for younger patients and for people whose medicines arent working well.
Surgically Implanted Devices :- Surgeons can place several types of devices in the heart
to improve function and symptoms, including:
Cardiac resynchronization therapy (CRT) device. A CRT device coordinates
contractions between the hearts left and right ventricles.
Implantable cardioverter defibrillator (ICD). An ICD helps control lifethreatening arrhythmias that may lead to sudden cardiac arrest. This small device
is implanted in the chest or abdomen and connected to the heart with wires. If an
ICD senses a dangerous change in heart rhythm, it will send an electric shock to
the heart to restore a normal heartbeat.
Left ventricular assist device (LVAD). This device helps the heart pump blood to
the body. An LVAD can be used as a long-term therapy or as a short-term
treatment for people who are waiting for a heart transplant.
Pacemaker. This small device is placed under the skin of your chest or abdomen
to help control arrhythmias. The device uses electrical pulses to prompt the heart
to beat at a normal rate.
Heart Transplant :- For this surgery, a surgeon replaces a persons diseased heart with a
healthy heart from a deceased donor. A heart transplant is a last resort treatment for
people who have end-stage heart failure. End-stage means the condition has become so
severe that all treatments, other than heart transplant, have failed. For more information
about this treatment, go to the Heart Transplant Health Topic.
PREVENTION:- You can't prevent inherited types of cardiomyopathy. However, you can
take steps to lower your risk for diseases or conditions that may lead to or complicate
cardiomyopathy. Examples include coronary heart disease, high blood pressure, and heart
attack.
Doctor may advise you to make heart-healthy lifestyle changes, such as:

Avoiding the use of alcohol and illegal drugs

Getting enough sleep and rest

Heart-healthy eating

Physical activity

Quitting smoking

Your cardiomyopathy may be due to an underlying disease or condition. If you

treat that condition early enough, you may be able to prevent cardiomyopathy
complications. For example, to control high blood pressure, high blood
cholesterol, and diabetes:

Follow your doctors advice about lifestyle changes.

Get regular checkups with your doctor.

Take all of your medicines as your doctor prescribes.

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