Cardiomyopathy

What is cardiomyopathy?

Cardiomyopathy is a condition in which your heart muscle becomes inflamed and enlarged. Because it is enlarged, your heart muscle is stretched and becomes weak. This means it can’t pump blood as fast as it should.

If your heart muscle becomes too weak, you may develop heart failure (a serious condition that needs special treatment). Most people are only mildly affected by cardiomyopathy and can lead relatively normal lives. However, people who have severe heart failure may need a heart transplant.

Cardiomyopathy is different to a heart attack. Heart attacks also damage part of your heart muscle, but may be caused by something else.

Causes of cardiomyopathy

There are four main things that are known to cause cardiomyopathy.

Viral infection

An infection in your heart can damage the heart muscle, but it may not show up for months, or longer.

Alcohol

Drinking more than the recommended amount of alcohol can damage the heart and liver. Sometimes damage can be reversed if you stop drinking alcohol completely. 

Family history

If you have a family history of cardiomyopathy, your chances of developing it can increase.

Heart attack

One or more heart attacks can damage your heart muscle, leading to scar tissue. Scar tissue in your heart doesn’t contract like normal heart muscle, so the rest of your heart has to work harder, making the healthy parts tired and weak.

Signs and symptoms

Many people with cardiomyopathy do not have any symptoms. However, you may experience symptoms similar to heart failure because cardiomyopathy prevents your heart from working properly. These symptoms include:

• breathlessness
• tiredness
• swelling in your legs and abdomen due to fluid building up.

Types of cardiomyopathy

Dilated cardiomyopathy

This type occurs mostly in adults aged 20 to 60, and in men more than women.

When the heart muscle pumps it begins to stretch and become thinner (dilate). This means the heart muscle doesn’t contract normally, so can’t pump blood very well. Over time, the heart becomes weaker and heart failure can occur.

This type of cardiomyopathy can also lead to:

• heart valve problems
• irregular heartbeats (arrhythmias)
• blood clots in the heart.

Hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is very common – if affects one out of every 500 people. It affects people of any age.

HCM occurs if the heart muscle cells enlarge and cause the walls of the heart to thicken. This thickening may block blood flow out of the ventricle. If a blockage occurs, the heart must work harder to pump blood to the body. This can cause:

• chest pain
• dizziness
• shortness of breath
• fainting.

HCM can have other effects on the heart.

Restrictive cardiomyopathy

Restrictive cardiomyopathy tends to affect older adults. With this type of cardiomyopathy, the heart becomes stiff and rigid because abnormal tissue, such as scar tissue, replaces the normal heart muscle. As a result, the heart can’t pump properly and blood flow to the heart is reduced. This leads to problems such a heart failure or arrhythmias.

Arrhythmogenic right ventricular cardiomyopathy

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare type of cardiomyopathy that occurs when muscle tissue in one part of the heart is replaced with scar tissue.

This process disrupts the heart’s electrical signals and causes irregular heartbeats (arrhythmias). Symptoms may include palpitations and fainting after physical activity. This type of cardiomyopathy usually affects teenagers or young adults.

Diagnosis of cardiomyopathy

Cardiomyopathy is usually diagnosed with a chest X-ray, an echocardiogram (ultrasound of the heart), blood tests and a physical examination.

Unfortunately, because some people don’t experience any symptoms, the first sign can be sudden death.

Treatment of cardiomyopathy

Cardiomyopathy can be managed with medicines and treatments which relieve symptoms, as well as simple lifestyle changes.

Common medicines used to treat cardiomyopathy include:

• ACE inhibitors which block the effects of hormones that affect blood pressure to dilate blood vessels, which help to reduce the heart’s workload
• Fluid pills (diuretics) which help to remove excess fluid from the body
• Beta-blockers which prevent the effect of nerves that act on the heart and other parts of the body to lower heart rate and blood pressure, which reduces your heart’s workload
• Digoxin which helps the heart to pump more efficiently and to regulate an abnormal heart rhythm (arrhythmia).

Depending on the type of cardiomyopathy, surgery or an implantable device (such as an implantable cardiac defibrillator) may also be used to manage the condition.

Managing cardiomyopathy

As well as taking medicines as prescribed and having surgical treatment as required, you can help to reduce the effects of cardiomyopathy and the risk of more heart problems by making lifestyle changes.

Be smoke free
Quitting smoking is one of the most important things you can do to reduce your risk of further heart disease. Breathing in other people’s smoke (second-hand smoke) is also harmful.

Eat less salt
Salt causes your body to retain fluid, which can build up and put more strain on your heart. To reduce the amount of salt you eat, try:

• eating plenty of fresh fruit and vegetables
• choosing foods labelled ‘no added salt’, ‘low salt’, or ‘salt-reduced’ 
• avoiding highly salted seasonings, processed foods and takeaway foods that are high in salt
• using garlic, herbs and spices instead of salt
• avoid adding salt to cooking.

Limit alcohol
Alcohol can damage your heart. Talk to your doctor about how much alcohol you drink. With mild cardiomyopathy, one drink may be ok, however your doctor may recommend that you reduce the amount of alcohol you drink, or stop drinking alcohol altogether.

Do regular physical activity
Your body is designed to move. Regular, light- to moderate-intensity physical activity is good for your heart and is a great way to have fun.

Try to do some type of physical activity, such as going for a walk, cycling, lifting light weights and stretching each day. Do what you can without getting breathless or overtired. You should be able to talk normally, but be unable to sing.

Talk to your doctor about the type and level of physical activity that is suitable for you. Avoid strenuous activities unless your doctor has approved them.

Remember

• Cardiomyopathy is a condition where your heart becomes inflamed and weakened.
• There are a number of causes of cardiomyopathy but not everyone gets symptoms
• Cardiomyopathy can be treated with medication and surgery, but one of the most important strategies in managing this condition is to adopt a healthy lifestyle.

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