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Cardiomyopathy Cardiomyopathy
by Kimberly Allen, RN Cardiomyopathy is one of those umbrella terms used to cover a variety of diseases affecting the heart muscle.  Cardiomyopathy can... Cardiomyopathy

by Kimberly Allen, RN

Cardiomyopathy is one of those umbrella terms used to cover a variety of diseases affecting the heart muscle.  Cardiomyopathy can affect both males and females of all ages.  However, certain types of cardiomyopathy are more common in a particular age group as some are more common in males than females.  Cardiomyopathy can be either acquired, meaning it developed because of another disease, or it can be inherited, meaning you received the gene for the disease from your parents.heart as ticking bomb

Although there are four main types of cardiomyopathy there are then numerous types of cardiomyopathy that are determined by their individual cause.  There are a variety of illnesses both acquired and genetic that can lead to cardiomyopathy.  There are many other health conditions ranging from coronary artery disease and blood disorders to chronic alcoholism and metabolic disorders as well as both bacterial and viral infections.  There can also be genetic mutations including those that run in families that cause cardiomyopathy.  Of the four main types of cardiomyopathy dilated cardiomyopathy or DCM is the most common.  It is most often diagnosed in adults 20 to 60 years of age. Also, it is more common in men than women.  Though frequently the cause of DCM is unknown at least one third of those diagnosed with DCM inherited it from their parents.  DCM can also be caused by a variety of conditions ranging from long term alcohol abuse and drug use to viral infections.  DCM starts in the left ventricle which is the main pumping chamber of the heart.  The heart muscle stretches and becomes thinner causing the inner walls of the ventricle to become enlarged.  As the disease progresses it spreads to the other chambers of the heart, usually first to the right ventricle then up to the atria or upper chambers of the heart.  As the chambers of the heart stretch the heart muscle is unable to contract normally which impairs it’s ability to pump the blood.  Eventually the heart weakens to the point of developing heart failure.

Hypertrophic cardiomyopathy or HCM affects about 1 in every 500 people.  It can affect anyone at any age and affects both men and women equally.  HCM has been found to be a common cause of sudden cardiac arrest or SCA in young people, especially young athletes.  HCM develops when the cells of your heart muscle enlarge causing the walls of the ventricles to thicken.  The ventricles usually remain normal in size but with thicker walls which can impede the blood flow out of the ventricles.  HCM can also cause the wall between the ventricles to thicken and impede blood flow from the heart.  HCM can also cause problems with the mitral valve allowing blood flow to leak back through the valve.

Restrictive cardiomyopathy usually affects older adults.  In this type of cardiomyopathy scar tissue replaces the normal heart muscle tissue causing the ventricles to become stiff and unable to relax normally so it can fill properly which in turn causes the atria to become enlarged.  As the disease progresses it will eventually lead to arrhythmia’s even heart failure.  This type of cardiomyopathy is usually caused by certain diseases like hemochromatosis and amyloidosis as well as certain cancer treatments.

Arrhythmogenic right ventricle dysplasia or ARVD is the rarest of the four types of cardiomyopathy and usually affects teens and/or young adults.  ARVD can also cause sudden cardiac arrest in young athletes.  It develops when the muscle tissue in the right ventricle dies and is then replaced with scar tissue.  The scar tissue then interrupts the electrical signals in your heart leading to arrhythmia’s.  This type of cardiomyopathy is believed to be an inherited condition.

Some people don’t even realize they have cardiomyopathy because they have no symptoms and live long healthy lives.  However, in other people the disease can progress quickly with severe symptoms and lead to severe complications.

There are a variety of treatments available ranging from lifestyle changes and medications to surgery and implanted devices.  These treatments have improved over the years and can control your symptoms and reduce the potential for complications as well as prevent the disease from worsening.

cholesterol levels effect on heartTreating Cardiomyopothy

As music fans across the country take in the sad news that Randy Travis, a well known and loved country music singer, is suffering from severe viral cardiomyopathy many are asking how is this condition treated.

In most cases cardiomyopathy isn’t curable, however, there are some types of DCM or dilated cardiomyopathy that develop suddenly that resolve on their own.  Then there’s the others whose cardiomyopathy is severe enough to require treatment.  Treatment depends on a number of factors, in addition to age and overall health the type of cardiomyopathy you have and the severity of the damage to your heart muscle are the major factors considered when planning treatment.  The main goals of any treatment plan for all types of cardiomyopathy include slowing and/or stopping further damage to your heart muscle and improve heart function as well as reduce and possibly eliminate symptoms improving quality of life.  Other important goals include treating any other conditions that can impair heart function, like any blockage in your coronary arteries, and prevent complications like sudden cardiac arrest.

Treatment for cardiomyopathy can range from lifestyle changes and medications to surgery and implanted devices depending on the severity of your disease.  If your cardiomyopathy is in it’s early stages and your symptoms are mild with minimal heart damage your doctor will most likely recommend lifestyle changes.  Actually it doesn’t matter what the type or severity of your cardiomyopathy is, lifestyle changes will be a part of your plan of care.  However, in mild cases the disease frequently can be managed well without more aggressive treatment.  The lifestyle changes that your doctor is likely to recommend include a healthy diet and physical activity.  Your diet should contain fruits and vegetable as well as grains, half of which should be whole grains.  It’s important to eat foods that are low in both saturated and trans fats as well as cholesterol.  Choose healthier, leaner cuts of meat, fish and poultry and don’t eat the skin.  change to dairy products that are either low fat or fat free.  It’s also important to reduce your salt and sugar intake.  In addition to dietary changes, it’s important to exercise regularly and maintain a healthy weight as well as quit smoking if you’re a smoker and limit your alcohol intake.

In addition to lifestyle changes your doctor may recommend certain medications.  ACE inhibitors like lisinopril and captopril improve your hearts ability to pump.  And for those that are unable to take ACE inhibitors there’s angiotensin receptor blockers or ARB’s like Cozar and Diovan.  Beta blockers like Lopressor also improve heart function.  Lanoxin also called digoxin and digitalis has been around for a long time and continues to be effective in slowing your heartbeat as well as improving the strengnth of your hearts contractions.  It is effective in treating congestive heart failure improving your ability to manage you cardiomyopathy. If you are experiencing moderate to severe symptoms of congestive heart failure your doctor may also recommend diuretics like Lasix to reduce the fluid in your lungs improving your ability to breathe.

If lifestyle changes and medications are ineffective in managing your cardiomyopathy there are surgical procedures and implants that your doctor may recommend.  Today with the advances in technology most doctors will recommend the least process that can effectively treat your cardiomyopathy.  Today that usually means implants instead of open heart surgery.  The devices used today can be implanted using a catheter or with a very small incision done under local anesthesia.  For some types of cardiomyopathy a pacemaker which is a very small device that sends electrical signals to your heart allowing it to regulate as well as monitor your heartbeat.  For people with HCM that have a high risk of sudden cardiac arrest the doctor may recommend a device called an implantable cardioverter-defibrillator or ICD.  And ICD is about the size of a pager and is implanted in your chest same as a pacemaker.  It monitors your heartbeat continuously and should a life threatening arrhythmia occur the device is able to deliver electric shocks that are precisely calibrated to your heart.  Another device that can be implanted in either your chest or your abdomen that assists your heart in pumping blood  to the rest of your body is known as a Left Ventricular Assistive Device or LVAD.

Should your cardiomyopathy have progressed to the “end stage” and no other treatments have been effective as a last resort your doctor may recommend you consider a heart transplant.  This form of treatment is considered only when all other treatments have failed.

Kimberly Allen is a registered nurse with an AND in nursing. She has worked in ACF, LCF and psychiatric facilities, although she spent most of her career as a home health expert. She is now a regular contributor to HealthAndFitnessTalk.com, dispensing advice and knowledge about medical issues and questions. You can reach her with any comments or questions at  mussatti3@gmail.com.

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