Cardiomyopathy

What cardiomyopathy is and what happens in the heart

The word cardiomyopathy simply describes a disease of the heart muscle. Unlike coronary artery disease, which involves narrowing of the arteries that supply the heart, cardiomyopathy affects the structure and function of the heart muscle itself.

The heart is a remarkably resilient organ, but like any muscle it can become weakened, thickened or stiff. When the heart muscle changes in shape or strength, it may struggle to pump blood efficiently. In some cases the chambers of the heart become enlarged. In others the muscle becomes thickened, or too stiff to relax properly. These changes can interfere with normal circulation and can sometimes affect the heart's electrical system as well.

The severity of cardiomyopathy varies widely. Some people experience few symptoms and live normal lives with monitoring and treatment. Others may require more specialised care.

The main types of cardiomyopathy

There are several forms of cardiomyopathy, each affecting the heart muscle in a different way.

Advances in cardiac imaging have made it much easier to identify which type is present and to diagnose it accurately. Many people with hypertrophic cardiomyopathy live active lives, and regular monitoring is important to keep heart function and rhythm under review.

• Dilated cardiomyopathy. This is the most common type and occurs when the heart chambers become enlarged and the heart muscle becomes weaker. As the heart muscle stretches, its ability to pump blood efficiently decreases, which can cause fatigue, breathlessness and reduced exercise tolerance. It may develop because of genetic factors, previous viral infections, alcohol misuse or long-standing high blood pressure.
• Hypertrophic cardiomyopathy. This involves abnormal thickening of the heart muscle, particularly in the walls of the left ventricle. The thickened muscle can make it harder for the heart to pump efficiently, may sometimes obstruct blood flow leaving the heart, and can interfere with the heart's electrical system. It is often inherited, which means it can run in families.
• Restrictive cardiomyopathy. Here the heart muscle becomes stiff and less able to relax between beats. The pumping strength of the heart may remain relatively normal, but the stiffness prevents the chambers from filling properly with blood, which can lead to breathlessness and fluid retention. It is less common than the other forms and can occur because of certain medical conditions or diseases affecting the heart muscle.

What causes cardiomyopathy

Cardiomyopathy can be caused by genetic factors, long-term high blood pressure, infections, excessive alcohol intake or other medical conditions. In some cases no clear cause is identified.

Family history is particularly important. Where cardiomyopathy runs in families, screening of close relatives may help to detect the condition early. Identifying the underlying cause also helps to guide treatment and long-term monitoring.

• Genetic inheritance
• Previous viral infections affecting the heart
• Long-term high blood pressure
• Excessive alcohol consumption
• Certain medical conditions affecting other organs

Symptoms you may notice

Symptoms vary depending on the type of cardiomyopathy and how severe it is. Some people remain free of symptoms for long periods, while others notice a change in their energy levels or their breathing.

These symptoms are not unique to cardiomyopathy and can occur with a number of other heart conditions. Persistent or worsening symptoms should always be assessed by a doctor rather than put down to age or tiredness.

• Shortness of breath, especially during physical activity
• Fatigue or reduced stamina
• Reduced exercise tolerance
• Palpitations or an irregular heartbeat
• Chest discomfort
• Swelling in the legs, ankles or abdomen
• Episodes of dizziness or fainting

How cardiomyopathy is diagnosed

Diagnosis usually involves a combination of clinical assessment and specialised tests. Dr Jogiya usually begins with a physical examination and a discussion of your symptoms and your family history, then arranges the imaging and tests needed to see the heart muscle clearly.

Where an inherited form of cardiomyopathy is suspected, genetic testing may also be considered. Taken together, these investigations show which type of cardiomyopathy is present and help to decide the most appropriate treatment plan.

• An ECG, to assess the heart rhythm and look for changes in the heart's electrical activity
• An echocardiogram, an ultrasound scan that examines the structure of the heart and how well it pumps
• A cardiac MRI, which provides detailed images of the heart muscle
• Blood tests, to assess your overall health

How cardiomyopathy is treated

Treatment depends on the type of cardiomyopathy and the symptoms present. Many people are treated with medication that helps the heart to pump more effectively, helps to control the heart rhythm and blood pressure, and reduces strain on the heart muscle.

In some cases, implantable devices such as pacemakers or defibrillators may be required to manage abnormal heart rhythms.

Lifestyle advice also plays an important role. Reducing alcohol intake, eating a balanced diet, managing other risk factors such as high blood pressure and staying physically active within safe limits all support the heart. Regular follow-up appointments allow heart function to be monitored and treatment to be adjusted as needed.

Early detection makes a difference. When cardiomyopathy is identified early, treatment can begin before the heart muscle becomes severely weakened. Regular health checks are particularly worthwhile if you have a family history of heart disease.

When to seek help

Call 999 immediately if you have chest pain that does not settle, if you collapse or lose consciousness, or if you become suddenly and severely breathless.

Arrange a medical review if you notice unexplained breathlessness, ongoing fatigue, palpitations, swelling in your legs or ankles, or episodes of dizziness that keep returning. If a close relative has been diagnosed with cardiomyopathy, or has had a sudden cardiac death, say so when you book, because screening of close relatives can help to pick the condition up early.

Dr Jogiya will usually arrange the appropriate imaging and tests, explain what they show and discuss the most suitable management for your heart health.