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May 28, 2006
Cardiomyopathy
by SirGan
 Cardiomyopathy is literally a disease of the heart muscle. It is one very serious disease in which the heart muscle becomes inflamed and doesn't work as well as it should.Cardiomyopathy can be classified as primary or secondary. Primary cardiomyopathy can't be attributed to a specific cause, while secondary cardiomyopathy is due to specific causes, such as high blood pressure, heart valve disease, artery diseases or congenital heart defects. It's often associated with diseases involving other organs as well as the heart. Incidence of the conditionThe incidence of cardiomyopathy in US is 400,000 cases per year. This disease afflicts 2-3 million people in the United States. Several studies have found that 5 years after the initial presentation of the disease, 42% of women and 62% of men had died. Long-term survival was found to be inversely proportional to the severity of disease on initial diagnosis.
Signs and symptomsAlthough, some people who develop cardiomyopathy may have no signs and symptoms in the early stages of the disease, as the condition advances, signs and symptoms usually appear. Some of the most common signs are:
No matter what type of cardiomyopathy we are talking – important fact is that signs and symptoms tend to progress over time unless the condition is treated.
Possible causes and types of cardiomyopathyThe causes of the common forms of cardiomyopathy include:
This is definitely the most common form of cardiomyopathy, in which, the left ventricle- the heart's main pumping chamber, becomes enlarged and its pumping ability becomes less strong.
This type involves abnormal growth of heart muscle, mostly affecting the muscle of the left ventricle. Because of the thickening, the heart tends to stiffen and the size of the pumping chamber may shrink, interfering with heart's ability to deliver blood to body. This disorder can develop at any age, but it tends to be more severe among those diagnosed during childhood.
During this condition, the heart muscle becomes very rigid and less elastic, interfering with the ability to expand and filling of the heart's ventricles with blood between heartbeats or contractions. It can occur for no known reason or may result from diseases elsewhere in the body that affect the heart.
This is a type of dilated cardiomyopathy that usually begins about 10 years after heavy alcohol consumption. It can occur with both typical signs of heart failure, as well as with atrial fibrillation or other heart rhythm problems.
This is a dilated cardiomyopathy appearing in women during the last trimester of pregnancy, or after childbirth.
This is caused by heart attacks, which leave scars in the heart muscle. The affected myocardium is then unable to contribute to the pumping. The larger the scars the higher the chance there is of developing ischemic cardiomyopathy.
Although there are many conditions that can cause cardiomyopathy, in most people, the cause is unknown. In some people, however, doctors are able to identify a cause or contributing factors, including some that affect the heart and cardiovascular system. Some of the most common causes are also:
Screening and diagnosis of cardiomyopathyBefore any other tests, every doctor should conduct a physical examination and take a patient’s medical history, including asking about your family history of heart problems. If some doctor suspects in cardiomyopathy as a possible cause, patient may need to have several tests to confirm the diagnosis and rule out other conditions and some of the most common tests are:
It is understood that an X-ray image of heart will show whether it's enlarged or not!
This is very good diagnostic tool because it using sound waves or ultrasound to non-invasively create images of patient’s heart. Doctor can then view the size of heart and its motions.
This is also one noninvasive and very effective test. It can be simply done with small electrode patches that are being attached to patient’s skin to measure electrical impulses from heart. It can show disturbances in the electrical activity of heart, which may identify abnormal heart rhythms.
During this procedure, a thin tube called catheter is guided through patient’s blood vessels and into heart, where a small sample can be extracted for analysis in the laboratory. Not only that- it can also measure pressure within the chambers of patient’s heart.
Possible complications if left untreatedSeveral studies done in the past have proven that untreated cardiomyopathy can lead to several complications of which, some are very dangerous. Most common are:
It is logical that any of the types of cardiomyopathy can make a patient more susceptible to forming blood clots in their heart. Problem is that, if these clots are pumped out of the heart and enter circulatory system, they can obstruct the blood vessels and blood flow to vital organs, including your heart and brain. This is lethal condition! If clots develop on the right side of your heart, they may travel to your lungs. That’s why patients are given anticoagulant medications!
It is reasonable that, because in this condition heart is extremely enlarged, two of the heart's four valves may not close properly because they stay small! This is often leading to the backflow of blood and heart murmurs!
It is proven that all forms of cardiomyopathy can lead to abnormal heart rhythms.
Treatment of cardiomyopathyGoals of treatment include symptom relief, improved cardiac output, shortened hospital stays, fewer ED visits, reversal of injury process, and decreased mortality.
Most common treatments include:
Medications
Doctors often prescribe medications for dilated cardiomyopathy. Most commonly used are:
Pacemaker
Another option for some people with abnormal electrocardiograms is a special pacemaker that coordinates the contractions between the left and right ventricle (biventricular pacing). It is one device implanted in chest to continuously monitor heart rhythm and deliver precisely calibrated electrical shocks when needed to control abnormal, rapid heartbeats.
MedicationsMany doctor may recommend beta blockers such as Lopressor or calcium channel blockers such as verapamil (Calan, Isoptin), which can relax patient’s heart.
PacemakerFor some people, a pacemaker may be recommended.
OperationIn advanced cases of hypertrophic cardiomyopathy, a surgeon may remove a portion of the thickened muscle wall that interferes with normal blood flow.
Alcohol ablationYour doctor also may recommend a new therapy called alcohol ablation. This non-surgical procedure, which uses injected alcohol to destroy extra heart muscle, may reduce thickening and improve blood flow.
This type of cardiomyopathy can be easily treated! Doctor should recommend to patient to pay careful attention to salt and water intake and monitor weight daily. Treatment of fluid retention is with diuretics.
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