Cardiomyopathy

Medically Reviewed by Poonam Sachdev on October 17, 2024
Written by Sylvia Davis
9 min read

Cardiomyopathy is any disorder that affects the heart muscle. These disorders can cause yourheart to become abnormally enlarged, thickened, and/or stiffened. As a result, the heart muscle can't pump blood as well as it should. You may also have abnormal heart rhythms (arrhythmias). Cardiomyopathy tends to get worse over time and may lead to heart failure and the backup of blood into your lungs or other parts of your body.

 

There are many types of cardiomyopathy, and their effects can range from mild to serious. Some of the main types you might hear about include:

Dilated cardiomyopathy

This is the most common type. Several different health conditions can cause it. When you have it, the muscle in the main pumping chamber of your heart (the left ventricle) gets stretched and the chamber enlarges. Dilated cardiomyopathy tends to affect adults under 50. It can lead to heart failure over time.

Idiopathic dilated cardiomyopathy

This is not actually a separate type, but a term doctors use to refer to dilated cardiomyopathy for which they don't know the cause. "Idiopathic" is a term meaning there's no known cause. 

Arrhythmogenic cardiomyopathy

Also called arrhythmogenic right ventricular dysplasia, this type happens when muscle tissue in your heart's right ventricle dies and gets replaced by scar tissue. This may cause irregular heartbeats. This rare type most often affects teens and young adults.

Restrictive cardiomyopathy

With this type, scar tissue causes the ventricles of your heart to stiffen. This prevents them from filling with blood and pumping it out to the rest of your body. It can lead to arrhythmias or heart failure. This is the rarest type of cardiomyopathy.

Hypertrophic cardiomyopathy

When you have this type of cardiomyopathy, the walls of your heart chambers get thicker than they should be. They can become stiff and block the lower chambers of your heart, affecting blood flow. This type is usually caused by abnormal genes.

Transthyretin amyloid cardiomyopathy (ATTR-CM)

ATTR-CM causes deposits of a protein called transthyretin to build up in your heart. It can make the walls of your heart so stiff that your left ventricle can't fill with blood. This can lead to heart failure.

Left ventricular noncompaction cardiomyopathy

This rare type happens when your heart muscle doesn't develop properly while you're in the womb. It causes the muscle in your left ventricle to become thick and spongy, instead of firm. It can affect children or adults.

Other types of cardiomyopathy include:

  • Ischemic cardiomyopathy, which happens when arteries that send blood to the heart become narrowed
  • Peripartum cardiomyopathy, which you get during or shortly after pregnancy
  • Takotsubo cardiomyopathy or "broken heart syndrome," which is when intense stress affects your heart muscle

Cardiomyopathy can be inherited, which means your parents pass down a gene that causes it. Or it can be acquired, which means you get it due to another health condition or risk factor.

Things that could lead to acquired cardiomyopathy include:

  • Autoimmune diseases that affect your connective tissues, such as lupus, rheumatoid arthritis, and scleroderma
  • Chemotherapy
  • Diabetes and other metabolic disorders
  • High blood pressure
  • Heart disease or coronary artery disease 
  • Infections such as COVID-19, hepatitis, and HIV
  • Muscular dystrophy
  • Pregnancy complications
  • Overuse of alcohol, amphetamines, anabolic steroids, or cocaine
  • Sarcoidosis (the buildup of inflammatory cells in your heart)
  • Thyroid diseases
  • Vitamin or mineral deficiencies

Sometimes, doctors don’t know what caused cardiomyopathy.

People of all ages, genders, races, and ethnicities can get cardiomyopathy. Some types, such as dilated and ATTR-CM, are more common in men. Others, such as arrhythmogenic, tend to affect younger people. Black people are more likely to get dilated cardiomyopathy than white people.

Things that can increase your risk for cardiomyopathy include:

  • A family history of cardiomyopathy, heart failure, or sudden cardiac arrest
  • Health conditions that affect your heart
  • Uncontrolled high blood pressure
  • Chemotherapy or radiation for cancer treatment
  • A body mass index (BMI) over 30, which puts extra strain on your heart
  • Long-term misuse of alcohol
  • Long-term use of illicit drugs, such as amphetamines or cocaine
  • Pregnancy 
  • A very stressful experience, such as the death of a friend or family member

You can have cardiomyopathy that's so mild you don't have any symptoms at all. Or you might notice:

  • Shortness of breath
  • Long-lasting fatigue
  • Chest pain
  • A heartbeat that flutters or that feels fast or pounding
  • Swollen legs or ankles
  • A bloated belly
  • Dizziness or fainting
  • Coughing when you lie down

These symptoms are likely to get worse if you don't get treatment.

Pediatric cardiomyopathy symptoms

Children with cardiomyopathy may have:

  • Shortness of breath
  • Chest pain
  • Tiredness
  • Fast breathing
  • A fast or irregular heartbeat
  • A swollen belly
  • Dizziness or fainting

Babies might:

  • Gain too little weight
  • Be extremely sleepy
  • Have trouble feeding
  • Sweat a lot

If you have a family history of heart conditions, or if your doctor notices signs of cardiomyopathy during an exam, they may refer you to a heart specialist called a cardiologist.

To diagnose cardiomyopathy, the cardiologist will ask about your medical history and that of close family members. They'll do a physical exam along with diagnostic tests that may include:

Blood tests.The doctor will test a sample of your blood to check the function of your kidney, liver, and thyroid. They'll check your blood's iron levels and look for a type of protein that indicates heart failure. 

Chest X-ray. This can show them whether your heart looks enlarged.

Electrocardiogram (ECG or EKG). To see whether your heart is beating normally, a doctor or nurse attaches electrodes to your chest, arms, and legs. Signals from the electrodes allow the doctor to view your heart activity on a computer display.

Echocardiogram. This test uses sound waves to create images of your heart that show your doctor how well blood is flowing through it.

Exercise stress test. Your doctor monitors your heart as you walk on a treadmill or ride a stationary bike to see how exercise affects it. If you're unable to exercise, they can give you a drug to boost your heart rate like exercise does.

Ambulatory monitoring. You'll wear a portable device that tracks the electrical activity of your heart as you go about your day. A Holter monitor records this information all day for 1 or 2 days. An event monitor only checks your heart activity at certain times.

Cardiac CT scan. This test uses a series of X-rays taken from different angles to provide a comprehensive view of your heart.

Cardiac MRI. Radio waves and magnetic fields are used to create a two- or three-dimensional view of your heart.

Cardiac catheterization. For this test, a doctor will thread a small tube (catheter) through a blood vessel in your leg and up to your heart. This lets them measure pressure and blood flow and check for blockages.

Coronary angiography. During a cardiac catheterization, your doctor may also inject a dye that shows up on an X-ray. This allows them to look at blood flow and check for blockages.

Myocardial biopsy. Also during a catheterization, the doctor can remove a sample of your heart muscle so they can look for cell changes there.

Genetic testing. The doctor may recommend that your close relatives, such as your parents, siblings, and children, be screened for cardiomyopathy. This can show whether they're at risk of passing on the genes for the condition. It may also be an option if you're at risk for cardiomyopathy but don't have any symptoms.

Treatments for cardiomyopathy vary depending on what kind you have and how serious it is. Treatment won't cure cardiomyopathy but can help control symptoms and keep the condition from getting worse.

Wait and watch approach

If you don’t have symptoms, you may not need any treatment at all. And certain types of cardiomyopathy, such as dilated cardiomyopathy, sometimes go away on their own. Your doctor may choose to just keep an eye on your condition to see if it gets worse.

Medications for cardiomyopathy

Several types of medication can be used to treat cardiomyopathy. Depending on the type you have and what your symptoms are, your doctor may recommend:

  • Drugs that eliminate excess fluids and sodium from your body.
  • Drugs that help your heart pump blood by relaxing your blood vessels.
  • Drugs that slow your heart rate or help it become more regular. 
  • Blood thinners to prevent clots.
  • Drugs to reduce blood pressure.
  • Drugs that help your heart work better by balancing the levels of minerals in your blood called electrolytes.

if your condition is serious and drugs don’t improve your symptoms, your doctor may recommend a procedure such as:

Alcohol septal ablation. This procedure, used for hypertrophic cardiomyopathy, shrinks part of the heart muscle that has grown too thick. To do it, your doctor uses a catheter to send alcohol into an artery that supplies blood to the area.

Catheter ablation. For this procedure, a doctor passes a catheter through a vein to your heart. They then use hot or cold energy to make scars on your heart. These scars stop the electrical impulses that cause irregular heartbeats.

Septal myectomy. In this open-heart surgery, a surgeon removes part of the heart muscle wall called the septum. This boosts blood flow and helps your heart pump better.

Heart transplant. If no other treatments have worked, you could be a candidate for a heart transplant. This is surgery to replace your damaged heart with a healthy heart donated by someone who has died.

Implant devices for cardiomyopathy

Another option is surgery in which a doctor places a device in your heart to help it perform better. These include:

  • Pacemaker, a device that stabilizes your heartbeat
  • Left ventricular assist device, a pump that sends blood out to the rest of your body
  • Implantable cardioverter defibrillator, which uses electrical shocks to correct heart rhythms
  • Cardiac resynchronization therapy device, which tracks irregular heart rhythms and delivers electrical shocks when needed

It's not possible to prevent inherited cardiomyopathy, but genetic testing can inform you about your risks if others in your family have it. Early diagnosis and treatment will improve your outcome.

You can work to prevent acquired cardiomyopathy by keeping your heart as healthy as possible. These healthy lifestyle changes can also help prevent complications if you've already been diagnosed with the condition. They include:

  • Keep your weight, blood pressure, and cholesterol levels in the range your doctor recommends.
  • Get regular physical activity. Ask your doctor what type and intensity are right for you.
  • Don't smoke.
  • If you drink alcohol, do so in moderation.
  • Avoid illicit drugs.
  • Follow a healthy diet rich in fruits, vegetables, and whole grains and low in sodium.
  • Get regular medical checkups.
  • Follow your doctor's treatment advice for any health conditions you have, such as diabetes or sleep apnea.
  • Take steps to manage stress.

The outlook for people with cardiomyopathy depends on what type they have and how serious it is. It can range from mild to life-threatening. It tends to get worse as time goes on.

While there's no cure for cardiomyopathy, treatment can improve symptoms and help prevent or slow down complications. Healthy lifestyle changes to improve your heart health are important, too.

Most people with the condition are able to live productive, healthy lives if they get the right treatment and follow their doctor's recommendations.

Cardiomyopathy is any disorder affecting your heart muscle. It can cause abnormal heartbeats and keep your heart from pumping blood as well as it should. There's no cure, but treatment can ease symptoms and help keep your condition from getting worse.

What is muscle cardiomyopathy?

All types of cardiomyopathy affect the heart muscle. In fact, it's sometimes called heart muscle disease. When the heart muscle becomes damaged, it affects how well the heart can pump blood out to the body.

What are the symptoms of an enlarged heart?

Cardiomyopathy can lead to an enlarged heart, which is when your heart is larger than it should be. It might be stretched out or thicker than normal. This doesn't always cause symptoms. But enlarged heart symptoms can include: 

  • Shortness of breath
  • Irregular heartbeat
  • Chest pain
  • Fatigue
  • Dizziness or fainting

What causes heart muscle thickening?

Hypertrophic cardiomyopathy makes your heart muscle thicker. This type of cardiomyopathy is usually inherited.

What is ischemic cardiomyopathy?

Ischemic cardiomyopathy is when you have reduced blood flow to your heart due to narrowing of the coronary arteries.

Hypertrophic vs. dilated cardiomyopathy: What is the difference?

In hypertrophic cardiomyopathy, your heart muscle thickens, usually in the wall between the heart's two ventricles. Your genes usually cause it.

With dilated cardiomyopathy, the muscle in a chamber of your heart gets stretched out, and the chamber enlarges. Doctors often don't know what causes it. Genetics is thought to play a role, and so do several other types of health conditions. Overuse of alcohol or drugs can also be a cause.

Both types of cardiomyopathy can keep your heart from pumping normally.

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