Although a cardiomyopathy diagnosis might seem intimidating at first, most patients can live full lives with the right treatment and lifestyle changes. Cardiomyopathy encompasses diverse conditions, so the manifestations can vary greatly among different people. While some people don’t need treatment, more progressed forms might require invasive options like open-heart surgery or even an heart transplant.
With the exception of secondary cardiomyopathies (caused by another underlying condition, like diabetes or an autoimmune disease), this disease can’t be cured or reversed. The goal of treatment is to:
- Manage the symptoms and prevent the disease from progressing further.
- Prevent possible complications like stroke, heart failure, or sudden cardiac death.
What are the symptoms of cardiomyopathy and how are they treated?
When the heart’s working at reduced capacity, the following symptoms can occur:
- Breathlessness. The left ventricle is the heart’s main pumping chamber. It receives oxygenated blood from the lungs and pumps it to the rest of the body. If the ventricle is weakened, it might not be able to process all of the blood coming from the lungs, eventually leading to fluid accumulation in the lungs which makes breathing harder.
- Swelling of the legs, ankles and other body parts. Swelling also results from fluid accumulation, when the heart's pumping power is reduced.
- Arrhythmia (irregular heartbeat). Abnormalities in the timing or pattern of the heartbeat can happen as a result of structural changes, or it can be a symptom of heart failure. Your heart contracts upon receiving an electrical signal from specialized groups of heart cells that spread through the heart’s electrical network. Changes in the electrical conductivity of the heart muscle (as well as other structural changes) can disrupt normal electrical signaling, causing abnormal heartbeats. In the case of heart failure, the heart can’t meet the body's demands and tries to make up by pumping faster. Some arrhythmias are harmless, but others can lead to life-threatening events like cardiac arrest.
- Fainting, dizziness, and exhaustion.
The type of treatment you'll get depends on the severity of your symptoms and how damaged your heart is, as well as the type of cardiomyopathy you have. Overall health and age also play an important role, since some procedures carry more risks for certain groups.
Which medications are used to treat cardiomyopathy?
Medication is, followed by lifestyle changes, the first line of treatment for cardiomyopathy. The type of drug(s) your doctor might prescribe depend on the type and severity of your symptoms and the risk of complications. Even if you don’t have any symptoms, medications can be important for the prevention of stroke and sudden cardiac death. The goal of improving the quality of life and survival rate is most often achieved through different combinations of drugs.
Classes of drugs that can used include:
- ACE inhibitors (angiotensin-converting enzyme inhibitors). This group of medications prevents angiotensin II from forming by blocking the enzyme responsible for its conversion. Angiotensin II is a hormone that constricts the blood vessels, causing the blood pressure to rise. ACE inhibitors also act to raise the level of bradykinin, which dilates the blood vessels and lowers blood pressure, taking some strain off the heart.
- Angiotensin II receptor blockers (ARBs). This group also works by blocking the effects of angiotensin II and it is usually used for people who don’t respond well to ACE inhibitors. They block the receptors on the cells that recognize angiotensin II which prevents the cells from responding to the presence of angiotensin II.
- Beta-blockers (beta-adrenergic blocking agents). They act by blocking the receptors that bind epinephrine and norepinephrine, hormones produced by the adrenal gland that mediate the "fight or flight response". These hormones raise blood pressure (by constricting the blood vessels) and cause your heart to beat faster. The main effects of beta-blockers are lowered blood pressure and slower heart rhythm.
- Diuretics ("water pills"). Diuretics reduce excess fluid in your body, which can help with several symptoms, like breathlessness and swelling.
- Digoxin. Digoxin is one of the most efficient medications used to treat symptoms of heart failure. It slows the heart rate and makes heart contractions stronger which makes it more efficient in pumping blood.
- Anticoagulants (blood-thinning medications). This group prevents your blood from clotting which lowers the risk of stroke, one of the complications of cardiomyopathy.
- Antiarrhythmics. They are used to treat abnormal heart rhythm and include several different classes like calcium-channel blockers and beta-blockers. Arrhythmias can sometimes be difficult to treat and might require other options like implantable devices.
What types of implantable devices can help patients with cardiomyopathy?
- Implantable cardioverter-defibrillator (ICD). This is a small, battery-powered device inserted in your chest, where it monitors your heart rhythm. When it senses a dangerous heart rhythm, it delivers a small electrical shock through wires connected to the heart, known as defibrillation. ICDs are used in high-risk patients to help prevent cardiac arrest, especially those caused by ventricular tachycardia (fast heart rate that originates from the ventricles).
- Pacemaker. This device is placed under the skin in the chest or the abdomen. It delivers electrical pulses that maintain normal heart rhythm. It can help when the heart rhythm is too slow (bradycardia), too fast (tachycardia), or chaotic.
- Ventricular assist device (VAD). VAD is usually used in patients with end-stage heart failure when other treatment options have failed. It’s a battery-operated mechanical pump that helps blood travel from the right (RVAD), left (LVAD) or both ventricles (bifunctional VAD). It’s used for patients who are awaiting a heart transplant or to improve and lengthen life for those who are not candidates for a heart transplant.
Which procedures can help with cardiomyopathy?
In hypertrophic cardiomyopathy, the wall that separates the right and left side of the heart, called the septum, can thicken and limit the passage of blood through the heart, causing the heart to be less efficient in pumping blood. Procedures that reduce septum thickness and help remove obstruction are:
- Septal myectomy. This is a type of open-heart surgery in which the part of the septum that causes obstruction is excised.
- Alcohol septal ablation. ASA is a less invasive alternative to septal myectomy in which alcohol is injected directly into the heart. It causes a small, controlled heart attack which causes the excess tissue to die. However, it comes with its own set of risks and the choice between ASA and septal myectomy is a complex medical decision.