Cardiomyopathy: All You Need To Know

Cardiomyopathy is a disease of the myocardium or the heart muscle. It is a progressive disease in which the heart muscle weakens and cannot contract adequately enough. This means it is unable to pump blood properly to the rest of the body. In this condition, the heart muscle fails in its function of supplying oxygen-rich blood to the rest of the body and removing carbon dioxide from the body. Before we go into the different types of cardiomyopathy and other details, let us first get a better understanding by examining the way our heart functions.

Our heart relies on electrical signals generated by a group of cells in the upper chamber, or the atrium of the heart, to contract and pump blood to the body. First, the upper chamber contracts and sends blood to the lower chambers (ventricles) of the heart. Then the ventricles contract pumping blood to the body. At the next set of an electrical signal, the upper chamber is refilled with the deoxygenated blood. The amount of blood that the heart pumps in a specific period is called Cardiac Output.

Therefore, in a nutshell, cardiomyopathy implies a reduction in the heart’s cardiac output. There are many types of cardiomyopathy.

• Dilated Cardiomyopathy: This is the most common type which occurs when the heart muscle is too weak to pump blood efficiently. The muscles stretch and the heart becomes an enlarged chamber.
• Hypertrophic Cardiomyopathy: In this condition, the heart walls thicken and prevent blood from flowing through the heart. This is usually caused by a prolonged duration of high blood pressure, diabetes or thyroid disease, although it can also be genetic.
• Restrictive Cardiomyopathy: It is the least common form of cardiomyopathy which occurs when the ventricles stiffen and cannot relax enough to fill up with blood. It can occur due to heart disease.
• Arrhythmogenic Right Ventricular Dyspepsia: This is also genetic and involves replacing muscle in the right ventricle with fat and extra fibrous tissue.

Besides these, there are other types of cardiomyopathy, such as:

• Peripartum Cardiomyopathy: This occurs during or after pregnancy where the heart weakens in the final month of pregnancy or within five months of delivery.
• Alcoholic Cardiomyopathy: As the name suggests, this condition occurs due to excessive consumption of alcohol.
• Ischemic Cardiomyopathy: This is when the heart is unable to pump blood to the body due to coronary artery disease.
• Pediatric Cardiomyopathy: When the disease affects a child, the condition is referred to by this name.

What are the causes and risk factors of Cardiomyopathy?

Cardiomyopathy can be caused by many factors including:

• Uncontrolled high blood pressure
• Problems with the heart valve
• Diabetes
• Alcohol Abuse
• Chemical poisoning (e.g. lead & arsenic)
• Neuromuscular disorders such as muscular dystrophy
• Excessive alcohol consumption
• Severe obesity
• Amyloidosis: Buildup of abnormal proteins in the body
• Sarcoidosis: Accumulation of inflammatory cells forming lumps, usually in the lungs, skin or lymph nodes.
• Hemochromatosis: Accumulation of iron in the body
• Nutritional deficiencies such as Kwashiorkor (deficiency of protein), Beri Beri (deficiency of thiamine or vitamin B1) and Scurvy (deficiency of vitamin C).
• Autoimmune diseases like rheumatoid arthritis, scleroderma etc.
• Complications due to cancer therapies
• Electrolyte imbalance
• Using certain drugs such as cocaine, amphetamine and anabolic steroids.

What are the symptoms of Cardiomyopathy?

When the heart is unable to properly pump blood to the body, it can result in symptoms such as:

• General weakness and fatigue

• Shortness of breath on exertion

• Chest pains

• Swelling of legs, ankles and feet

• Lightheadedness and dizziness

• Bloating of the abdomen due to buildup of fluid

• Heart palpitations such as rapid or pounding heartbeat, occasional skipped heartbeat, or abnormal heart rhythms such as ventricular fibrillation.

• Fainting

How is cardiomyopathy diagnosed?

The diagnosis begins with the doctor taking an accurate and complete medical history of the patient and that of his/her family. The doctor then assesses the different symptoms and their intensity, for example, fatigue, weakness, shortness of breath, whether the condition is worsened due to exercise, verifying the presence of underlying illnesses such as high blood pressure, high cholesterol and diabetes. If the doctor suspects a case of cardiomyopathy, he/she may conduct the following tests:

• X-ray: This will show whether the heart is enlarged or not.
• Blood Tests: These can help in screening for anaemia or any other abnormalities in the electrolyte level and the kidney & liver function.
• Electrocardiogram: This test will help detect any abnormalities in the electrical activity of the heart by measuring its electrical impulses.
• Echocardiogram: This test involves using sound waves to produce images of the heart. This helps the doctor check the heart valves for any signs of defect. :
• Scanning: Different screening tests like MRI and CT Scans involve using magnetic fields and radio waves to generate accurate images of the heart.

What is the Treatment of Cardiomyopathy?

The goal of treatment is to manage the signs and symptoms, maximise the cardiac output and prevent further damage and loss of function. The treatment options are:

• Medications: Medicines may be prescribed to treat high blood pressure, prevent water retention and improve the heart’s pumping ability, and blood flow.
• Surgically implanted devices: Several devices can be implanted near the heart to improve its function. Pacemakers are used to control arrhythmias, Ventricular assist device (VAD) helps in blood circulation through the heart and can be used in the interim period while waiting for a heart transplant. An Implantable Cardioverter-Defibrillator (ICD) delivers electric shocks when needed to control abnormal heart rhythms; however, it doesn’t help in actually treating the disease.
• Radiofrequency Ablation: In this process, doctors insert long, flexible catheters through the blood vessels to the heart. These are fitted with electrodes at their tips which treat an abnormal spot of heart tissue.
• Septal Myectomy: This is an open-heart surgery in which the surgeon removes part of the thickened wall or septum, that separates the two heart chambers. This helps improve the blood flow.
• Heart Transplant: This is a final option and is considered when all the other treatment measures have failed to produce the desired effect.

Some simple lifestyle changes and home remedies can help prevent the onset of cardiomyopathy. These include heart-healthy lifestyle changes such as quitting smoking, limiting alcohol consumption, following a healthy, nutritious diet and exercising regularly.