Can Cardiomyopathy be prevented?

Cardiomyopathy Overview

Cardiomyopathy (kahr-dee-o-my-OP-uh-thee) is a condition where the heart muscle is abnormal. The main types of cardiomyopathy include dilated, hypertrophic and restrictive cardiomyopathy. Cardiomyopathy makes it harder for your heart to pump and deliver blood to the rest of your body. Cardiomyopathy can lead to heart failure.

Cardiomyopathy can be treated. The type of treatment you’ll receive depends on which type of cardiomyopathy you have and how serious it is. Your treatment may include medications, surgically implanted devices or, in severe cases, a heart transplant.

Types of Cardiomyopathy

Dilated Cardiomyopathy
Dilated cardiomyopathy is the most common type of the disease. It mostly occurs in adults aged 20 to 60. Men are more likely than women to have this type of cardiomyopathy.

Dilated cardiomyopathy affects the heart’s ventricles and atria. These are the lower and upper chambers of the heart, respectively.

The disease often starts in the left ventricle, the heart’s main pumping chamber. The heart muscle begins to dilate (stretch and become thinner). This causes the inside of the chamber to enlarge. The problem often spreads to the right ventricle and then to the atria as the disease gets worse.

When the chambers dilate, the heart muscle doesn’t contract normally. Also, the heart can’t pump blood very well. Over time, the heart becomes weaker and heart failure can occur. Symptoms of heart failure include fatigue (tiredness); swelling of the ankles, feet, legs, and abdomen; and shortness of breath.

Dilated cardiomyopathy also can lead to heart valve problems, arrhythmias, and blood clots in the heart.

Hypertrophic Cardiomyopathy
Hypertrophic cardiomyopathy is very common and can affect people of any age. About 1 out of every 500 people has this type of cardiomyopathy. It affects men and women equally. Hypertrophic cardiomyopathy is the most common cause of sudden cardiac arrest (SCA) in young people, including young athletes.

This type of cardiomyopathy occurs when the walls of the ventricles (usually the left ventricle) thicken. Despite this thickening, the ventricle size often remains normal.

Hypertrophic cardiomyopathy may block blood flow out of the ventricle. When this happens, the condition is called obstructive hypertrophic cardiomyopathy. In some cases, the septum thickens and bulges into the left ventricle. (The septum is the wall that divides the left and right sides of the heart.) In both cases, blood flow out of the left ventricle is blocked.

As a result of the blockage, the ventricle must work much harder to pump blood out to the body. Symptoms can include chest pain, dizziness, shortness of breath, or fainting.

Hypertrophic cardiomyopathy also can affect the heart’s mitral valve, causing blood to leak backward through the valve.

Sometimes the thickened heart muscle doesn’t block blood flow out of the left ventricle. This is called nonobstructive hypertrophic cardiomyopathy. The entire ventricle may become thicker, or the thickening may happen only at the bottom of the heart. The right ventricle also may be affected.

In both types (obstructive and nonobstructive), the thickened muscle makes the inside of the left ventricle smaller, so it holds less blood. The walls of the ventricle also may stiffen. As a result, the ventricle is less able to relax and fill with blood.

These changes cause increased blood pressure in the ventricles and the blood vessels of the lungs. Changes also occur to the cells in the damaged heart muscle. This may disrupt the heart’s electrical signals and lead to arrhythmias.

Rarely, people who have hypertrophic cardiomyopathy have no signs or symptoms, and the condition doesn’t affect their lives. Others have severe symptoms and complications, such as serious arrhythmias, an inability to exercise, or extreme fatigue with little physical activity.

Rarely, people who have this type of cardiomyopathy can have SCA during very vigorous physical activity. The physical activity can trigger dangerous arrhythmias. If you have this type of cardiomyopathy, talk to your doctor about what types and amounts of physical activity are safe for you.

Restrictive Cardiomyopathy
Restrictive cardiomyopathy tends to mostly affect older adults. In this type of the disease, the ventricles become stiff and rigid. This is due to abnormal tissue, such as scar tissue, replacing the normal heart muscle.

As a result, the ventricles can’t relax normally and fill with blood, and the atria become enlarged. Over time, blood flow in the heart is reduced. This can lead to problems such as heart failure or arrhythmias.

Arrhythmogenic Right Ventricular Dysplasia
Arrhythmogenic right ventricular dysplasia (ARVD) is a rare type of cardiomyopathy. ARVD occurs when the muscle tissue in the right ventricle dies and is replaced with scar tissue.

This process disrupts the heart’s electrical signals and causes arrhythmias. Symptoms include palpitations and fainting after physical activity.

ARVD usually affects teens or young adults. It can cause SCA in young athletes. Fortunately, such deaths are rare.

Other Names for Cardiomyopathy

• Alcoholic cardiomyopathy. This term is used when overuse of alcohol causes the disease.
• Congestive cardiomyopathy.
• Diabetic cardiomyopathy.
• Familial dilated cardiomyopathy.
• Idiopathic cardiomyopathy.
• Ischemic cardiomyopathy. This term is used when coronary artery disease or heart attack causes the disease.
• Peripartum cardiomyopathy. This term is used when the disease develops in a woman shortly before or after she gives birth.
• Primary cardiomyopathy.

Other names for Hypertrophic Cardiomyopathy

• Asymmetric septal hypertrophy
• Familial hypertrophic cardiomyopathy
• Hypertrophic nonobstructive cardiomyopathy
• Hypertrophic obstructive cardiomyopathy
• Idiopathic hypertrophic subaortic stenosis

Other names for Restrictive Cardiomyopathy

• Infiltrative cardiomyopathy

Other names for Arrhythmogenic Right Ventricular Dysplasia

• Arrhythmogenic right ventricular cardiomyopathy
• Right ventricular cardiomyopathy
• Right ventricular dysplasia

Can cardiomyopathy be prevented?

Although cardiomyopathy is one of the less frequent forms of heart disease, it’s still important to be aware of the role heredity plays in the disease and to be familiar with its symptoms.

Check your family’s medical history to learn if you are at risk. Even if nobody in your family has cardiomyopathy, you need to know the warning signs:

• unexplained shortness of breath
• bloating
• fainting
• chest pains

If you have any of these symptoms, see your doctor. Also, because drinking too much alcohol, eating foods without the proper vitamins, and exposure to toxins can all cause cardiomyopathy, you can lower your risk by living a heart-healthy lifestyle.

Differential diagnosis

• Coronary artery disease.
• Mitral valve disease.
• Athlete’s heart: prolonged isometric training may produce heart changes resembling some features of hypertrophic cardiomyopathy.
• Amyloidosis.
• Hypertensive heart disease: severe, chronic systolic and diastolic hypertension.
• Valvular and subvalvular aortic stenosis.
• Infundibular pulmonary stenosis.
• Ventricular septal defect.
• Constrictive pericarditis.

How is Cardiomyopathy be treated?

There’s no cure for cardiomyopathy, but the treatments described below are usually effective at controlling symptoms and preventing complications.

Not everyone with cardiomyopathy will need treatment. Some people only have a mild form of the disease that they can control after making a few lifestyle changes.

Lifestyle changes
If the cause for your cardiomyopathy isn’t genetic, it should generally help to:

• follow a healthy diet and take gentle exercise
• quit smoking (if you smoke)
• lose weight (if you’re overweight)
• avoid or reduce your intake of alcohol
• get plenty of sleep
• manage stress
• make sure any underlying condition, such as diabetes, is well controlled

Medication
Medication may be needed to control blood pressure, correct an abnormal heart rhythm, remove excess fluid or prevent blood clots.

Read about:

• medication for high blood pressure
• beta-blockers to treat an irregular heartbeat or heart failure
• diuretics to remove excess fluid from your body if this has caused swelling
• anticoagulants such as warfarin to prevent blood clots
• medication to treat heart failure

Hospital procedures
In some people with obstructive hypertrophic cardiomyopathy, the septum (the wall dividing the left and right side of the heart) is thickened and bulges into the main heart chamber. They may need to have either:

• an injection of alcohol into their heart – this is to reduce part of the muscle in the septum
• a septal myectomy – heart surgery to remove part of the thickened septum (the mitral valve may be repaired at the same time, if necessary)