Cardiomyopathy: Causes, Symptoms, and Treatment

Cardiomyopathy, which affects your heart muscle, can reduce your heart’s blood pumping power and lead to serious consequences such as heart failure over time. While some types may be genetically inherited, others develop due to external factors such as hypertension, infection, or alcohol. This disease can lead to sudden cardiac arrest at a young age, as well as being one of the most common causes of heart failure in the elderly.

What Is Cardiomyopathy?

Cardiomyopathy is a heart muscle disease in which the normal structure or function of your heart muscle is impaired. Your heart either enlarges, thickens, or hardens, which prevents it from pumping blood adequately to the body. As a result, the oxygen and nutrients your body needs cannot be transported sufficiently.

What Are the Types of Cardiomyopathy?

Cardiomyopathy is divided into four main types according to changes in the structure and function of the heart muscle. Each type can occur for different reasons and may require different treatment approaches.

The main types of cardiomyopathy are:

• Dilated cardiomyopathy is the most common type. Your heart enlarges, muscle walls thin, and pumping power decreases.
• Hypertrophic cardiomyopathy occurs when the heart muscle thickens, preventing the heart from filling adequately with blood. It has strong genetic transmission and can cause sudden death at a young age.
• Restrictive cardiomyopathy is rarely seen; the heart muscle hardens so it cannot relax sufficiently and therefore cannot fill adequately.
• Arrhythmogenic right ventricular cardiomyopathy mainly affects the right heart chamber. Heart muscle is replaced by fat and connective tissue. This condition can lead to serious arrhythmias.

What Causes Cardiomyopathy?

The causes of cardiomyopathy can be both genetic and environmental. If there is a history of heart disease in your family, you may have a genetic predisposition. However, alcohol use, hypertension, having had a heart attack, diabetes, thyroid disorders, and some infections can also weaken your heart muscle over time.

Some chemotherapy drugs, connective tissue diseases, and rare diseases such as iron accumulation can also lead to cardiomyopathy. In genetically inherited forms (especially hypertrophic and arrhythmogenic types), the disease can show symptoms even at young ages.

The main causes of cardiomyopathy are:

• Genetic Causes: Hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy usually result from genetic mutations.
• Viral Infections: Some viral infections (such as myocarditis) can cause inflammation in the heart muscle, leading to dilated cardiomyopathy.
• High Blood Pressure (Hypertension): High blood pressure that is not controlled for a long time can cause your heart to work harder, leading to muscle thickening.
• Alcohol and Drug Use: Excessive alcohol consumption and substances like cocaine can damage the heart muscle, causing dilated cardiomyopathy.
• Autoimmune Diseases: Diseases such as systemic lupus erythematosus can trigger cardiomyopathy by causing inflammation in the heart muscle.
• Diabetes: Uncontrolled diabetes can damage the heart muscle.

What Are the Symptoms of Cardiomyopathy?

Cardiomyopathy may not be noticed in the early stages, but as it progresses, it manifests itself with symptoms that affect your daily life. Shortness of breath, weakness, and easy fatigue are the most common complaints. In some people, the first symptom may be palpitations or fainting.

As the disease progresses, symptoms such as swelling in the ankles, waking up from sleep with shortness of breath at night, or difficulty climbing hills may also be seen. In hypertrophic cardiomyopathy, one should be careful due to the risk of sudden fainting or sudden death, especially during sports.

Who Gets Cardiomyopathy?

Cardiomyopathy can occur at any age. However, genetic forms are mostly seen in young adults. Individuals with a family history of heart disease or sudden death at a young age are especially at risk.

Cardiomyopathy can also develop in high blood pressure patients, people who have had heart attacks, those who have used alcohol for many years, and patients receiving chemotherapy. In young individuals who engage in intense sports, there may be a risk of sudden death when underlying hypertrophic cardiomyopathy is overlooked.

How Is Cardiomyopathy Diagnosed?

To diagnose a person suspected of having cardiomyopathy, heart imaging is first performed. Echocardiography (heart ultrasound) is the basic method for evaluating the heart’s muscle structure and pumping power.

ECG is used to evaluate your heart rhythm. If arrhythmia is suspected, 24-hour Holter monitoring may be needed. If necessary, muscle structure is examined in detail with cardiac MRI. In some special cases, endomyocardial biopsy (taking a piece from the heart muscle) may be performed to clarify the diagnosis.

In genetically inherited types, family screening and genetic tests are also included in the diagnostic process.

How Is Cardiomyopathy Treated?

The main goal in treatment is to reduce the load on your heart, control arrhythmias, and prevent possible complications. Treatment differs for each type of cardiomyopathy and is planned specifically for you.

• In dilated cardiomyopathy, heart function is supported with heart failure medications (beta blockers, ACE/ARB, diuretics). If your heart is very weakened, ICD (implantable cardioverter defibrillator) or pacemaker implantation may be necessary. This device protects your heart against sudden cardiac arrest.
• In hypertrophic cardiomyopathy, beta blockers are used when thickened heart muscle blocks blood flow. In advanced cases, a portion of the thickened muscle is surgically removed (myectomy) or the narrow area is thinned by giving alcohol to the heart muscle (alcohol septal ablation).
• In restrictive cardiomyopathy, treatment is directed at the cause; if there is an underlying disease (such as amyloidosis), it is treated first.
• In arrhythmogenic right ventricular cardiomyopathy, arrhythmias are prominent and ICD implantation is usually required.

What Are the Risks and Complications of Cardiomyopathy?

When left untreated, cardiomyopathy can have serious consequences. It carries risks of heart failure, recurrent arrhythmias (ventricular arrhythmias), cardiac arrest, and sudden death.

Especially in hypertrophic and arrhythmogenic right ventricular cardiomyopathies, sudden death can be seen at a young age. Therefore, detailed screening is important in athletes or young individuals with a family history of heart disease.

What Are the Prevention Methods for Cardiomyopathy?

It is not possible to prevent types of cardiomyopathy caused by genetic reasons. However, some lifestyle changes and precautions can be taken to prevent types that occur due to acquired causes.

To prevent cardiomyopathy, you can:

• Avoid excessive alcohol consumption and smoking
• Keep diseases such as high blood pressure and diabetes under control with regular treatment and follow-ups
• Early diagnosis and treatment are important for conditions such as myocarditis that viral infections can cause
• If there is a history of cardiomyopathy in your family, you and your relatives should be evaluated by a cardiologist

How Should Nutrition Be in Cardiomyopathy?

A nutrition plan that supports your heart positively affects the course of the disease. It is important to reduce salt, stay away from processed foods, and eat vegetables and fruits rich in potassium. If heart failure develops, fluid and sodium restriction may be applied. Alcohol and caffeine can trigger arrhythmias in some patients. Your daily nutrition plan should definitely be reviewed by a dietitian and your physician.

Can You Exercise with Cardiomyopathy?

Exercise is beneficial for most patients, but the dose needs to be adjusted well. Controlled walking and light exercises protect your heart health. However, in some types such as hypertrophic cardiomyopathy, intense sports can pose serious risks. Therefore, your exercise capacity should be evaluated with echocardiography and stress testing; your exercise program should definitely be determined with physician recommendation.

When Should You Consult a Doctor?

If you have shortness of breath, palpitations, chest pain, or fainting episodes, you should definitely not take these complaints lightly. If there is a history of heart disease or sudden death at a young age in your family, you should see a cardiology specialist even if you don’t have any complaints yet. With early diagnosis and proper treatment, you can maintain your quality of life for many years.

Reference: Cardiomyopathy