Cardiomyopathy is a change in the heart muscle of an often unexplained cause.
The condition for making a diagnosis of “cardiomyopathy” is the absence (or exclusion after examination) of congenital malformations, valvular heart defects, damage caused by systemic vascular diseases, arterial hypertension, pericarditis, as well as some rare variants of damage to the cardiac conduction system.
Causes of the disease
The etiology of this pathology has not yet been fully studied. There are a number of probable causes that can cause cardiomyopathy:
- hereditary predisposition (a genetic defect that causes the abnormal formation and functioning of myocardial muscle fibers);
- various viral infections (Coxsackie, herpes, flu, etc.);
- previously transferred myocarditis;
- damage to heart cells by toxins and allergens;
- violation of endocrine regulation (negative effect of growth hormone and catecholamines);
- disorders of the immune system.
Common symptoms of cardiomyopathy include:
- shortness of breath (especially during exercise);
- swelling of the legs;
- causeless cough;
- pale skin;
- blue fingers;
- pain in the chest;
- frequent fainting;
- increased sweating;
- significant decrease in performance;
- sleep disorder and others.
The treatment of cardiomyopathy is long-lasting and quite complicated. It depends on the form of the disease, the age of the person and the severity of his/her condition. Cardiomyopathy in children can be congenital. It develops due to a violation of embryogenesis. The prognosis for the detection of this disease is not always comforting. Over time, all symptoms worsen. This leads to the development of pathologies that are incompatible with life.
To diagnose cardiomyopathy, a doctor can prescribe such instrumental studies:
- X-rays of light;
- heart MRI;
- endomyocardial biopsy.
Types and symptoms of cardiomyopathy
- Dilatation. There are no obvious symptoms of cardiomyopathy of this type until heart failure develops. Symptoms of the disease depend on the involvement of one or both chambers of the heart at the beginning of the pathological process. Due to oxygen deficiency caused by cardiomyopathy, shortness of breath occurs, fatigue increases, and heart rate increases. At the initial stage of the disease, the listed symptoms are associated only with the effect of physical activity, and over time they also occur at rest. A patient suffers from insomnia, dizziness, pain in the chest and under the left shoulder blade, swelling;
- Hypertrophic. With this pathology, the relaxation (reduction of extensibility) of the heart chambers is impaired, blood circulation worsens, the shape of the left ventricle changes, the septum thickens, as a result, the pressure rises, and the walls of the outflow tract become thinner. Other symptoms of hypertrophic cardiomyopathy are the patient’s tendency to fainting, increased heart rate. With this pathology, rhythm disturbance can even lead to sudden death;
- Restrictive. At the initial stage, the complaints of patients practically do not differ from those listed for other types of cardiomyopathy. But over time, swelling of the legs, shortness of breath and fatigue are replaced by more severe symptoms. The liver ceases to function normally, increases in size, then dropsy develops. The instability of the heart rhythm reaches such an extent that it causes frequent fainting;
- Arrhythmogenic. The most common symptom is ventricular arrhythmia. The patient’s complaints include paroxysmal heart palpitations (most often induced by significant physical exertion). This type of disease can be hereditary.
Consequences and complications
Progressive heart failure is a characteristic complication for all types of cardiomyopathy. In addition, arterial and pulmonary thromboembolism, cardiac conduction disturbances, severe forms of arrhythmia can develop. The risk of sudden cardiac death is very high. If the patient has bad habits, such as smoking and drinking alcohol, the prognosis worsens significantly. The presence of thromboembolism and tachycardia can also affect life expectancy, especially in the absence of treatment for cardiomyopathy. Today, alleviating the course of the disease for such patients is possible thanks to modern technologies for early diagnosis.
Treatment of cardiomyopathy is usually a long-term drug therapy, however, in some cases, surgical intervention may be required. In any case, only a cardiologist can diagnose cardiomyopathy and select a treatment tactic.
Medical treatment for cardiomyopathy includes:
- ACE inhibitors;
- mineralocorticoid receptor antagonists;
The following heart operations are prescribed as a surgical treatment for cardiomyopathy:
- excision of the interventricular septum;
- implantation of the external left ventricle;
- heart transplant.
Who treats this disease?
The treatment of cardiomyopathy is aimed at stopping the further progression of the pathology, correcting the symptoms and preventing complications.
When a diagnosis of cardiomyopathy is established, treatment recommendations are given by the following specialists:
- a cardiologist;
- a cardiac surgeon or a transplant surgeon (if surgery required);
- a therapist;
- a family doctor.
The prognosis for patients with cardiomyopathy is unfavorable: the steady progression of heart failure causes a high probability of arrhythmic, thromboembolic complications, as well as sudden death of the patient. According to statistics, with dilated cardiomyopathy, 5-year survival is 30%. Systematic treatment is able to stabilize the patient’s condition for an indefinite period. There are also known cases of exceeding 10-year survival after surgery for heart transplantation. The surgical treatment gives a positive result but is associated with a high risk of death of the patient during or after surgery. Women with cardiomyopathy are not recommended to become pregnant because gestation and childbirth are associated with a high probability of maternal death.
To date, there are no preventative measures for hereditary cardiomyopathy. However, some recommendations have been developed to reduce the risk of developing concomitant diseases that worsen its course – myocardial infarction, arterial hypertension. In general, prevention includes a healthy lifestyle, including physical education and rejection of tobacco and alcohol. To detect a background disease (arterial hypertension, hypercholesterolemia or diabetes mellitus) at its early stage, it is important to follow the following recommendations:
- regularly visit a doctor and undergo examinations;
- follow all the recommendations of a specialist on changing lifestyle, daily routine, diet, etc.;
- take medicines and other drugs in strict accordance with the doctor’s prescription.
Patients with a high degree of risk of sudden cardiac death are recommended to get implantation of a cardioverter-defibrillator, a device for stopping threatening arrhythmias.