Cardiomyopathy: Symptoms, Diagnosis and Treatment Options (video)

Cardiomyopathy is a disease which interferes with the heart’s ability to effectively pump blood to the rest of the body. Usually caused by some type of damage to the heart muscle, it is one of the most common conditions among cardiac patients.

In this video, San Diego Health host Susan Taylor talks with Rajeev Mohan, MD, a cardiologist at Scripps Clinic, about how cardiomyopathy affects the heart and how it is diagnosed and treated.

Cardiomyopathy means that the heart is not squeezing properly, which prevents organs and tissues throughout the body from getting enough blood to function properly. It affects men and women equally, most often developing in people who have underlying cardiomyopathy risk factors, such as chronic high blood pressure, high cholesterol, diabetes and coronary artery disease. In some cases, cardiomyopathy can be genetic in nature and passed from one generation to the next.

 There are several different kinds of cardiomyopathies:

• Hypertrophic cardiomyopathy occurs when the left ventricle of the heart muscle gets too thick.
• Dilated cardiomyopathy causes the heart to balloon out and become much larger than normal.
• Amyloid cardiomyopathy, which is becoming increasingly common, happens when proteins are deposited within the heart, causing it to thicken.
• Arrhythmogenic cardiomyopathy is caused by an abnormal heart rhythm that causes heart muscle dysfunction.
• Stress-induced cardiomyopathy, also known as broken heart syndrome, is triggered by a very significant source of stress.

“It can be an emotional stressor or a physical stressor, but basically stress-induced cardiomyopathy causes the heart to go into almost a stunned phase where it just doesn’t squeeze properly,” says Dr. Mohan. “More often than not, it is a relatively short episode where once the stressor is resolved, we can get some recovery in the heart muscle function.”

Cardiomyopathy symptoms are similar to those of congestive heart failure. A main symptom is shortness of breath, particularly when people are exerting themselves just by going for a walk or climbing up a flight of stairs. Random heart palpitations, where it feels like your heart is racing or skipping a beat, can also be warning signs.

Another common symptom is swelling, especially in the hands and feet.

“Because the heart is trying to keep up with the demands of the body, it starts to retain extra fluid, and that starts to leak out and cause swelling,” explains Dr. Mohan.

The most common tool used to diagnose cardiomyopathy is an echocardiogram, which is an ultrasound test that provides a detailed view of the heart and can show areas that are enlarged or thickened.

If left untreated, cardiomyopathy can be fatal. Treatment depends on what type of cardiomyopathy is causing the problem. Some types have very specific treatments. Hypertrophic cardiomyopathy, for example, can be treated with a medication that targets the left ventricle. Specific medications are used to treat amyloid cardiomyopathy as well.

“But for the other types of cardiomyopathy, there are medicines that we use which we call guideline-directed medical therapy,” says Dr. Mohan. “That’s a fancy term for a number of different medicines that we use to help strengthen the heart muscle and prolong life.”

Many people with cardiomyopathy may be candidates for different types of implantable devices. In many cases, these devices are implanted into the chest wall using minimally invasive surgical techniques. The most common is called an implantable cardioverter defibrillator (ICD), which monitors the heart’s rhythm and detects any dangerous abnormalities. If needed, the ICD will deliver a shock to the heart to restore its normal rhythm.

Patients who have more advanced hypertrophic cardiomyopathy may be candidates for a surgical procedure that implants a pump into the damaged left ventricle. Called a left ventricular assist device, the pump effectively takes over the work of the left side of the heart.

“Patients can live many, many years after an implant of this device,” says Dr. Mohan.

Because this is an open-heart surgery, recovery is longer than with an ICD. Patients are typically in the hospital for about two weeks, with full recovery taking about two months.

The most effective way to help prevent cardiomyopathy is to make sure any underlying risk factors, such as diabetes or high blood pressure, are being treated. Dr. Mohan also encourages patients to do as much physical activity as they can manage.

If you experience symptoms, such as shortness of breath, irregular heartbeats or swelling in your legs, make an appointment with your doctor.

“It’s really important for all of us to make sure that we’re listening to our bodies, and if we start experiencing any symptoms that may be heart-related, that we get it checked out sooner rather than later,” says Dr. Mohan. “We want to make sure that we’re looking at the heart more closely so we can better understand if somebody has cardiomyopathy.”