Types of Cardiomyopathies

The main types of cardiomyopathy include

1. Dilated cardiomyopathy
2. Hypertrophic cardiomyopathy
3. Restrictive cardiomyopathy
4. Arrhythmogenic right ventricular dysplasia (ARVD), or arrhythmogenic right ventricular cardiomyopathy (ARVC)
5. Takotsubo cardiomyopathy, also called as stress cardiomyopathy OR Broken heart syndrome

Why people get Cardiomyopathy

1. Some types of cardiomyopathy are inherited (Since Birth) and are seen in children and younger people.
2. Some develop due to other underlying cause
3. Family history of cardiomyopathy
4. In some cases, the reason is unknown.

Risks/causes for Cardiomyopathy)

This depends on the type of Cardiomyopathy:

1. May be caused by a mutation or change in some of the genes in heart muscle proteins
2. High blood pressure
3. Aging
4. Diabetes, HIV, Hyperthyroidism, Hypothyroidism, Hemochromatosis (deposition of excessive Iron) and Amyloidosis (Deposition of excessive protein)
5. Pregnancy complications
6. Connective tissue disorders
7. Alcohol
8. Heavy metals
9. Cocaine, also known as coke
10. Viral infection or infectious disease

How to diagnosis Cardiomyopathy

The Diagnostic tests depends on the type of Cardiomyopathy.

A medical doctor/cardiologist diagnoses Cardiomyopathy. He will take a detailed history of the symptoms and do physical examination. This is usually followed by various tests.

Symptoms of Coronary Artery Disease

The symptoms of Cardiomyopathy depend on various types of cardiomyopathies. There may be No or Very little signs or symptoms in the early stages, which may gets worse as the disease advances. The symptoms include:

1. Shortness of breath on exertion or even at rest
2. Legs, ankles and feet Swelling
3. Bloating of the abdomen due to fluid buildup
4. Cough while lying down
5. Fatigue, tiredness, lethargy
6. Palpitation (Heartbeats that feel rapid, pounding or fluttering)
7. Chest discomfort or pressure
8. Dizziness, lightheadedness and fainting

Tests for Cardiomyopathy

The doctor may request from a list of tests from below, in order to confirm and treat Cardiomyopathy

1. Electrocardiogram (ECG or EKG)
2. Blood tests
3. Chest X-ray
4. Echocardiogram
5. Coronary angiography
6. Right heart Catheterization
7. Cardiac computerized tomography (CT) scan
8. Cardiac MRI
9. Myocardial biopsy
10. Genetic testing or screening. Genetic testing for your first-degree relatives — parents, siblings and children

Treatment of Cardiomyopathy

The Diagnostic tests depends on the type of Cardiomyopathy and the stage at which it is diagnosed

1. The Treatment of Cardiomyopathy includes medications, surgery/Interventions and medical devices & Advance therapies.
1. The treatment of Cardiomyopathy may be lifelong and needs systematic approach.
2. The AIM of the treatment is to improve the symptoms of heart failure and make it stronger as much as possible.
3. The Cardiomyopathy sometimes improve largely by treating the underlying cause. For example, treating the valve disease, heart attack and heart rhythm problems.

1. Medications
   
   Your doctor will prescribe various medications based on your individual needs and your underlying other conditions and risk factors. These are as follows:
1. Angiotensin-converting enzyme (ACE) inhibitors
1. These drugs help relax your arteries, lowers the blood pressure and decrease the workload on the heart
2. Examples include enalapril, Lisinopril, Ramipril and captopril.
2. Angiotensin II receptor blockers
1. These drugs help relax your arteries, lowers the blood pressure and decrease the workload on the heart similar to Angiotensin-converting enzyme (ACE) inhibitors.
2. Examples include losartan and valsartan
3. Beta-blockers
1. Beta-blockers reduces the heartbeats and reduces blood pressure.
2. Beta-blockers also help blood vessels relax and improve blood flow to heart muscle
3. This drug may help in limiting or reverses some of the damage to your heat.
4. Examples include carvedilol, atenolol, metoprolol and bisoprolol.
4. Diuretics
1. Also called as “ water pills”
2. It makes you pass more urine in order to remove excessive fluid from the body, particularly lungs and legs.
3. Example includes Furosemide (Lasix).
4. It may affect other minerals in the body, therefore the doctor may prescribe supplements of minerals in order to keep the normal level of potassium and magnesium
5. Aldosterone antagonists
1. This is also a different type of water pill. This has a beneficial effect on the longevity of your heart
2. This drug has an important effect in the body by increasing Potassium levels. . The doctor may request for regular blood tests.
3. Examples are spironolactone and eplerenone.
6. Digoxin
1. This drug increases the strength of your heart muscle and therefore helps in very weak heart
2. Can be used in slowing the heartbeat in patients with atrial fibrillation
2. Surgery/interventions:
1. If your Cardiomyopathy is due to weakness of heart muscles, Valves (doors of your heart) or blockages in the arteries of heart, you may need:
1. CABG
2. PCI
3. Heart valve repair or replacement
4. Alcohol Sptal ablation ( Hypertrophoc Obstructive Cardiomyopathy)
5. Septal Myomectomy ( Hypertrophoc Obstructive Cardiomyopathy)
3. Medical Devices
   
   You may need other advance therapies includes:
1. Implantable cardioverter-defibrillators (ICDs)
2. Cardiac resynchronization therapy (CRT), or biventricular pacing.
3. Ventricular assist devices (VADs)
4. Heart transplant.

1. Implantable cardioverter-defibrillators (ICDs)
1. An implantable cardioverter-defibrillator (ICD) is a small biscuit sized device which is used to help regulate very fast dangerous electrical impulses (current) which if not treated may lead to stopping of heart ( cardiac arrest). The procedure is performed in a catheterization (catheter) lab of the hospital or operation theatre
2. Cardiac resynchronization therapy (CRT), or biventricular pacing
1. In this treatment, A special pacemaker is implanted, which sends timed electrical impulses to both lower chambers of the heart's (the left and right ventricles) so that the heart pump in a more coordinated and efficient manner.
2. In some devices, ICD may be used and it is then called as biventricular ICD
3. Ventricular assist devices (VADs)
1. Also known as mechanical circulatory support device (Artificial heart).
2. This is implanted, via operation and the device is able to pump blood from the lower chambers of your heart (the ventricles) to the rest of your body.
3. Usually implanted in patients who are awaiting heart transplantation.
4. Heart transplant
1. In some patients, despite multiple medications and devices implantations (as above), the heart failure gets worse, therefore need their diseased heart replaced with a healthy donor heart.
2. There is a long waiting list for Heart transplants (limited donors) and available in few limited countries in the world.
3. A team of doctors at a transplant center decides patient fitness for a heart transplant.

How to live with Cardiomyopathy

1. Diet and Life style changes:
   If you had a Cardiomyopathy, you must work on your lifestyle changes: these changes include:
1. Stop smoking and avoid exposure to passive smoking.
2. Eat a healthy diet with limited amounts of saturated fat; eat whole grains, and many fruits and vegetables and Restrict sodium in your diet
3. Treat diseases or conditions that can increase your risk of angina, such as diabetes, high blood pressure and high blood cholesterol and stress.
4. Get regular medical check-ups.
5. Limit alcohol consumption to one to two drinks or fewer a day.
6. Maintain a healthy weight and maintain weight monitoring diar
7. Get an annual flu shot to avoid heart complications from the virus
2. Exercise and sports Cardiomyopathy
1. Regular exercise helps improve heart muscle function after a heart attack and helps prevent a heart attack. Walking 30 minutes a day, five days a week can improve your health. (Discuss with your doctor about a safe exercise plan).
2. Your doctor may suggest a walking program.
3. For Sports, discuss with your doctor regarding each sports you are interested.
3. Cardiac rehabilitation
1. Very important program run by doctors and medical team to help you recover from your Cardiomyopathy
2. Cardiac rehabilitation programs generally focus on four main areas — medications, lifestyle changes, emotional issues and a gradual return to your normal activities.
3. The above changes will be tailored, according to your individual needs and the amount and severity of heart failure.
4. Cardiomyopathy and Driving
1. You can drive as long as your doctor is agreed and your signs and symptoms are in control.
2. You must inform your licensing authority and get advice if you drive large goods vehicles (LGV) or passenger-carrying vehicles (PCV).
5. Cardiomyopathy and Working
1. you can usually go back to your work
2. If your job involves heavy lifting or manual labourer, discuss with your employer.
6. Cardiomyopathy and Sexual Life
1. Most people can safely perform sexual activity but usually depends on your physical comfort, psychological readiness and previous sexual activity.
2. Some heart medications can affect sexual function. Your doctor can then prescribe alternative medications particularly beta blockers ( consider Ivabradine)
3. You should NOT use Viagra if you are on regular nitrates tablets.
7. Cardiomyopathies & Family Members
1. All members of the family should be routinely checked and repeated yearly
2. They should have ECG and ECHO checked on regular basis

Cardiomyopathy and support services

1. Having a Cardiomyopathy is one of the scariest experiences of your life. People may experience Fear, anger, guilt and depression after a diagnosis.
2. Discussing them with your doctor, a family member or a friend might help. Or consider talking to a mental health provider or joining a support group.

Please refer to online support groups such as: British Heart Foundation (BHF)