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Heart Health

Cardiomyopathy

Cardiomyopathy

Cardiomyopathy refers to diseases relating to the heart muscle where due to damage or abnormalities of the heart muscle, the heart enlarges, thickens or becomes rigid. These results in a condition called heart failure.
 

There are various types of cardiomyopathy such as:

1. Dilated cardiomyopathy (DCM)

  • DCM is the most common form of cardiomyopathy.
  • It occurs when the heart muscle starts stretching (dilates), becoming thinner.
  • As the chambers of the heart dilate, the heart muscles are unable to contract normally and cannot pump blood very well.

2. Hypertrophic cardiomyopathy (HCM)

  • HCM is another common form of cardiomyopathy.
  • It occurs when the heart muscle cells enlarge, causing the walls of the heart chambers to thicken.
  • Even though the sizes of the heart chambers appear normal, the heart muscles are unable to pump blood effectively.
  • Sometimes, the walls thicken to an extent that it may block the flow of blood through the chambers of the heart. When this happens, the condition is called obstructive hypertrophic cardiomyopathy.

3. Infiltrative heart disease

  • Infiltrative heart disease refers to a diverse group of disease that causes deposition of abnormal substances within the heart tissue, such as amyloid.
  • Due to these depositions, the heart muscles fail to contract efficiently.
  • The cause of infiltrative heart diseases can either be inherited or acquired through various other diseases that affect different parts of the body, such as connective tissue disease.

4. Restrictive cardiomyopathy

  • This is a relatively rare form of cardiomyopathy.
  • It occurs when the heart muscles become stiff, losing their normal elastic behaviour. 
  • When the heart is meant to relax to allow blood to fill its chambers, it is unable to do so.

5. Radiation cardiomyopathy

  • This form of cardiomyopathy occurs in patients who have had exposure to radiation treatment in the chest area. 
  • An example would be patients who have undergone radiation therapy for breast cancer.
  • The radiation received has been associated with scarring of the heart muscle, which then leads to the thickening and inefficiency of the heart. The electrical conduction of the heart can be affected too, worsening the cardiomypathy.

Some of these cardiomyopathic conditions are inherently familial (genetically transmitted). What this means is that certain members of the same family may acquire these forms of cardiomyopathies without experiencing any symptoms.


Some patients do not experience any symptoms at all whilst others may not exhibit symptoms during the early stages of the disease, developing them as the heart continues to weaken. 

As the condition worsens, and the heart weakens, the signs and symptoms of heart failure occur. 
 

Common symptoms include:

  • Swollen ankles/legs from fluid retention
  • Chest pain (angina)
  • Shortness of breath that occurs due to excessive fluid in the lungs
    • On exertion
    • At night
    • On lying flat
  • Fatigue as a consequence of insufficient blood and oxygen delivered to the other organs and muscles
  • Weight loss
  • Weight gain due to fluid overload in the body

The doctor will take a complete medical history and give you a physical examination.

If there is a suspicion of a cardiomyopathy, the following tests will be performed:

  • Echocardiography (ECHO)
  • Magnetic resonance imaging (MRI)
  • A specialised form of scan called positron emission tomography
  • Electrophysiological study (EPS) if you present with irregular heart rhythms
  • An endomyocardial biopsy
  • Genetic testing for selected conditions

These tests will help the doctor to determine:

  • The exact diagnosis
  • The type of cardiomyopathy based on assessing the tissue sample taken during a biopsy
  • The risk of the disease to the patient

and be used for family screening.


Cardiomyopathies are generally managed with medications. When the complication of heart failure is manifested, usual guideline-based optimal medical therapy is provided to the patients. 
 

In selected patients who are at risk or already suffer from electrical storms, an implantable pacemaker may be considered. 



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