Cardiomyopathy

Cardiomyopathy is a disease of the heart muscle that occurs when the heart loses its ability to pump blood and, in some cases, heart rhythm is disturbed, leading to irregular heartbeats or arrhythmias. Usually, the exact cause of the muscle damage is never found.

About 50,000 Americans are affected by cardiomyopathy and the condition is a leading reason for heart transplantation. At California Pacific Medical Center, more than 50% of heart transplants are performed as a result of this disease.

There are three types of cardiomyopathies, based on physical changes that occur in the heart:

Dilated (congestive) Cardiomyopathy

This type of cardiomyopathy is most common and occurs when disease-affected muscle fibers lead to enlargement, or dilation, of one of more chambers of the heart, weakening the heart's pumping ability. The heart tries to cope with the pumping limitation by further enlarging and stretching-a process known as "compensation."
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Hypertrophic Cardiomyopathy

The growth and arrangement of muscle fibers are abnormal, leading to thickened heart walls. The thickening reduces the size of the pumping chamber and obstructs blood flow. It also prevents the heart from properly relaxing between beats, causing it to fill with blood. Eventually, this limits the pumping action.
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Restrictive Cardiomyopathy

The walls of the ventricles stiffen and lose their flexibility due to infiltration by abnormal tissue. As a result, the heart cannot fill adequately with blood and eventually loses its ability to pump properly.
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The treatment of cardiomyopathy depends on its cause. In general, therapy begins with the elimination of risk factors such as alcohol consumption. Weight loss and dietary changes, especially salt restriction, may also be advised in addition to lifestyle changes.

Medical options used to treat the condition include:

  • Drugs (diuretics, vasodilators, digitalis) to control heart failure
  • A pacemaker or implantable automatic defibrillator to prevent fatal arrhythmia
  • Drugs to suppress the immune system
  • Antiarrhythmic drugs to correct abnormal heart rhythms
  • Surgery to thin the abnormally thick section of the heart wall.

    Advanced Disease

    For patients with advanced disease, heart transplantation greatly improves survival. Because of the scarcity of donor hearts, some critically ill cardiomyopathy patients with declining heart function use a small, implanted mechanical pump as a bridge to transplantation. Called left ventricular-assist devices (LVADs), these pumps take over part or virtually all of the heart's blood pumping activity. The devices provide only temporary assistance and are not used as substitutes for heart transplantation.

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