Cardiomyopathy

Cardiomyopathy is disease in which the heart muscle becomes weakened, stretched, or has another structural problem. It often occurs when the heart cannot pump or function well.

Most people with cardiomyopathy have heart failure.

There are many types of cardiomyopathy, with different causes. Some of the more common ones are:

• Dilated cardiomyopathy is a condition in which the heart becomes weak and the chambers get large. As a result, the heart cannot pump enough blood out to the body. It can be caused by many medical problems.
• Hypertrophic cardiomyopathy (HCM) is a condition in which the heart muscle becomes thick. This makes it harder for blood to leave the heart. This type of cardiomyopathy is most often passed down through families.

• Ischemic cardiomyopathy is caused by a narrowing of the arteries that supply the heart with blood. It makes the heart walls thin so they DO NOT pump well.
• Restrictive cardiomyopathy is a group of disorders. The heart chambers are unable to fill with blood because the heart muscle is stiff. The most common causes of this type of cardiomyopathy are amyloidosis and scarring of the heart from an unknown cause.
• Peripartum cardiomyopathy occurs during pregnancy or in the first 5 months afterward.

When possible, the cause of cardiomyopathy is treated. Medicines and lifestyle changes are often needed to treat the symptoms of heart failure, angina and abnormal heart rhythms.

Procedures or surgeries may also be used, including:

• A defibrillator that sends an electrical pulse to stop life-threatening abnormal heart rhythms
• A pacemaker that treats a slow heart rate or helps both sides of the heart beat at the same time
• Coronary artery bypass (CABG) surgery or angioplasty that may improve blood flow to the damaged or weakened heart muscle
• Heart transplant that may be tried when all other treatments have failed

Recently, implantable artificial heart pumps have been developed. These may be used for very severe cases. However, not all people need or are able to have this advanced treatment.

The outlook depends on many different things, including:

• Cause and type of cardiomyopathy
• How well the condition responds to treatment
• The severity of the heart problem

Heart failure is most often a long-term (chronic) illness. It may get worse over time. Some people develop severe heart failure. In this case, medicines, surgery, and other treatments may no longer help.

People with certain types of cardiomyopathy are at risk for dangerous heart rhythm problems.

Falk RH, Hershberger RE. The dilated, restrictive, and infiltrative cardiomyopathies. In: Bonow RO, Mann DL, Zipes DP, Libby P, Braunwald E, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 65.

McKenna WJ, Elliott P. Diseases of the myocardium and endocardium. In Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 60.

McMurray JJV, Pfeffer MA. Heart failure: management and diagnosis. In Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 59.

O’Connor CM, Rogers JG. Heart failure: pathophysiology and diagnosis. In Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 58.