Overview
Cardiomyopathy means disease of the heart muscle. The walls of the heart's chambers become stretched, thickened or stiff, which affects how well the heart pumps blood around the body. It can affect people of any age. The main types are:
- Dilated: the muscle stretches and thins, and cannot squeeze properly
- Hypertrophic: the muscle thickens, so the chambers hold less blood; this type is usually inherited
- Restrictive: the muscle is stiff and the heart cannot fill properly; this is rare
- Arrhythmogenic: normal muscle is replaced by scar and fatty tissue, which causes rhythm problems
- Broken heart syndrome (takotsubo): a surge of stress hormones temporarily weakens the heart
Symptoms
Some people have no symptoms for a long time. When symptoms appear they can include:
- Breathlessness
- Tiredness, even after rest
- Swollen ankles, feet, legs or tummy
- A racing, pounding or irregular heartbeat (palpitations)
- Dizziness or fainting
- Chest pain
In babies and young children, signs can include poor feeding, fast breathing, vomiting, irritability and poor growth.
When to see a doctor
See a doctor soon if you have new or worsening breathlessness, tiredness, swollen ankles, palpitations or dizziness. If a close relative has cardiomyopathy or died suddenly from a heart problem, ask a doctor whether you should be checked. People with known cardiomyopathy need regular reviews.
Causes
Many types are inherited, caused by gene changes passed through families. Others develop because of another problem, such as:
- Long-standing high
- A heart attack, or a viral infection that inflames the heart muscle
- Heart valve problems
- Heavy drinking, and drugs such as cocaine and amphetamines
- Diabetes, thyroid disease and some other long-term illnesses
- Pregnancy (peripartum cardiomyopathy, which is rare)
- Severe emotional or physical stress (broken heart syndrome)
In many people the cause is never found.
Risk factors
- A family history of cardiomyopathy, or a close relative who died suddenly from a heart problem
- High that is not controlled
- Heavy alcohol use or drug misuse
- Diabetes, obesity or thyroid disease
- A previous heart attack or viral heart infection
- Some cancer treatments, such as or radiation
Complications
- Heart failure
- Irregular heart rhythms, including
- Blood clots
- Leaky heart valves
- Cardiac arrest, including sudden death in some inherited types
Prevention
Inherited types cannot be prevented, but finding them early and treating them lowers the risk of serious problems. For other causes it helps to:
- Control high and diabetes
- Limit alcohol and avoid recreational drugs
- Not smoke, eat a healthy diet and keep to a healthy weight
Diagnosis
A doctor asks about symptoms and family history, listens to the heart and may refer you to a heart specialist. Tests may include:
- An , which records the heart's rhythm
- An ( scan), the most common test, which shows the heart's size and how well it pumps
- An of the heart
- A heart rhythm monitor worn for a day or two
- Exercise tests
- Genetic testing for inherited types, so that relatives can be checked too
Treatment
There is usually no cure, but treatment can control symptoms, slow the disease and lower the risk of serious problems. Some people with no symptoms need no treatment. Treatment may include:
- Healthy habits: a healthy diet, gentle exercise, not smoking and less alcohol
- Medicines to lower , remove extra fluid, slow or steady the heart rate, or prevent blood clots
- A pacemaker to regulate the heartbeat, or an implantable defibrillator (ICD) to correct dangerous rhythms
- Procedures, such as catheter ablation for rhythm problems, or an operation or alcohol injection to reduce a thickened wall in hypertrophic cardiomyopathy
- A heart transplant, as a last resort
Broken heart syndrome is usually temporary and the heart often recovers. Ask the cardiologist what level of exercise is safe for you.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“A bigger heart means a stronger heart, like a bigger muscle.”What is true?
Fact
In cardiomyopathy the muscle is stretched thin, thickened or stiff, not stronger. In each case the heart pumps blood less well, and this can lead to heart failure or dangerous heart rhythms.
Myth“Fit young people and athletes cannot have a heart problem.”What is true?
Fact
Some types, such as hypertrophic cardiomyopathy, can affect young people and athletes, and some people have no warning symptoms. A doctor can check for it, especially if the family has a history of heart disease or sudden death.
Myth“If I have no symptoms, there is nothing to worry about.”What is true?
Fact
Some people with cardiomyopathy feel well, and some need no treatment. But regular check-ups matter because it can progress, and relatives of someone with an inherited type can be tested and watched early.
Myth“Once the heart muscle is weak, nothing can be done except a transplant.”What is true?
Fact
There is usually no cure, but treatment can control symptoms and prevent complications. Medicines, devices and procedures come first, and a heart transplant is kept as a last resort for severe cases.
Myth“People with heart disease should avoid all exercise.”What is true?
Fact
Gentle exercise is part of a healthy lifestyle for many people with cardiomyopathy. Some types, such as arrhythmogenic cardiomyopathy, can be made worse by strenuous exercise, so ask the cardiologist what is safe for you.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
Is cardiomyopathy the same as heart failure?
No. Cardiomyopathy is a disease of the heart muscle. Heart failure means the heart cannot pump enough blood for the body's needs. Cardiomyopathy can lead to heart failure, but not everyone with cardiomyopathy has it.
Does cardiomyopathy run in families?
Many types are inherited. If one person is diagnosed, the doctor may suggest checking close relatives, sometimes with a genetic test, so that any problem can be found and watched early.
Can the heart recover?
It depends on the type and cause. Broken heart syndrome is usually temporary, and some sudden-onset types may improve by themselves. Others are lifelong conditions that are managed with treatment and regular check-ups.
Can I have a baby if I have cardiomyopathy?
Not all treatments are safe during pregnancy or breastfeeding, so speak to the cardiologist before planning a pregnancy. A rare type, peripartum cardiomyopathy, can also develop during pregnancy or in the months after birth.
