Cardiomyopathies: An Attack on the Heart

When a health-related story pops up on the news, there’s a good chance it will at least partially involve the heart. The heart organ receives plenty of attention from doctors, media outlets and patients alike, and for good reason – to put it bluntly, you literally can’t live without it. Moreover, heart ailments exact a heavy toll on the American public, with heart disease ranking as the leading cause of death for Americans in 2009. Between heart disease, high blood pressure and the persistent risk of heart attack, a damaged heart muscle is the bane of existence of millions of adults.

With all this (well-deserved) focus on the most deadly heart-related maladies, more obscure diseases tend to get lost in the shuffle. A prime example of this is cardiomyopathy, a condition you probably haven’t heard of before reading this article. It would be an understatement to state that cardiomyopathies pose a significant risk to a patient’s health; the one-year mortality rate for this disease s is 20 percent, a figure that alarmingly swells to 70 to 80 percent by the five-year mark.

The grave effects of cardiomyopathies recently made headlines when Randy Travis, a Grammy-winning country music singer, was hospitalized in July 2013 after being stricken with this ailment. Travis contracted a case of viral cardiomyopathy, landing him in critical condition at a Texas hospital.

The Impact on the Heart and Body

Though its tongue-twisting name might indicate otherwise, cardiomyopathic symptoms are relatively easy to describe. In short, this condition usually causes the walls of the heart muscle to either thicken or harden. Consequentially, the heart is unable to take in a healthy amount of blood, and struggles to pump sufficient amounts of blood throughout the body. Given how your bodily tissues use blood as a car uses gasoline, this shortage of blood can have a devastating domino-effect on the body.

Despite its harrowing mortality rate, the initial stages of cardiomyopathy are surprising symptom-free. Because of this, patients are often oblivious the deteriorating condition of their hearts. It is only as the disease increases in severity that the patient begins to feel the effects of this disease. The most common symptoms are detailed in the following list.

• Breathlessness, which occurs even when the body is inactive.
• Swollen tissues in the legs, ankles and feet
• An accumulation of fluids in the abdominal cavity, causing the abdomen to bloat in size
• A nagging lack of energy
• Rapid and irregular heartbeats that give off a pounding or fluttering feeling
• Feelings of dizziness and lightheadedness. The patient may even faint.

The Main Types of Cardiomyopathy

While Randy Travis’ heart problems can be blamed on a virus, cardiomyopathies can be caused by several different triggers. In addition, the symptoms associated with cardiomyopathies can vary somewhat from patient to patient. Because of these factors, doctors typically divide cardiomyopathies into one of four categories:

Dilated Cardiomyopathy – The most commonly diagnosed form of cardiomyopathy, dilated cardiomyopathy occurs when the heart swells in size and grows feeble. In this state, the heart is unable to perform its main function (i.e. pump blood through the body) to its full capacity. The signs of dilated cardiomyopathy include chest pains, fatigue, declining appetite and coughing.

Dilated cardiomyopathy can be linked to a relatively large number of root causes, including substance abuse (specifically cocaine and alcohol), an abnormally fast heartbeat, autoimmune disorders and viral infections.

Hypertrophic cardiomyopathy – The culprit behind hypertrophic cardiomyopathy is hardwired into a patient’s DNA, or more specifically their genes. Within the body, a certain number of genes regulate the growth and development of the heart organ. When these genes mutate, the patient develops hypertrophic cardiomyopathy. Being a genetic disease, patients can easily transmit hypertrophic cardiomyopathy to their offspring.

It bears mentioning that many people with this condition exhibit no symptoms whatsoever. If symptoms do develop, they typically appear in the form of chest pains, fatigue, short palpitations and shortness of breath. In some cases, the patient may faint due to an irregular heartbeat.

Restrictive Cardiomyopathy – Older adults are the most likely demographic group to be diagnosed with restrictive cardiomyopathies. Unlike other types of cardiomyopathies, in which the heart’s tissues are enlarged or otherwise altered, this disease causes sections of the heart muscles to be replaced with completely different types of tissue (scar tissue is an example of such material).

These unhealthy tissues interfere with the heart’s ability to fill its ventricle chambers with fresh blood. As the disease progresses, the atria (upper chambers of the heart) expand and the patient may experience irregular heartbeat or heart failure. Restrictive cardiomyopathies tend to strike patients who have previously developed certain conditions, such as hemochromatosis, sarcoidosis and amyloidosis.

Arrhythmogenic Right Ventricular Dysplasia – An uncommon disease, arrhythmogenic right ventricular dysplasia mimics restrictive cardiomyopathies, in that healthy heart tissue is replaced by scar tissue. As its name indicates, only the right ventricle is affected; the left ventricle chamber remains untouched.

The formation of this scar tissue disrupts the electrical signals coursing through the heart, causing the heart to beat in an irregular manner. Patients are liable to experience fainting after performing physically strenuous activities, and may also develop heart palpitations (palpations occur when the heart beats at “pounding” or “racing” pace).

What Can be Done

As shown by its high mortality rate, cardiomyopathy patients face an uphill struggle when it comes to treating their disease. The method of treatment depends on which form of cardiomyopathy has afflicted the patient.

Dilated Cardiomyopathy

• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin receptor blockers (ARBs)
• Digoxin
• Diuretics
• Beta blockers

Hypertrophic Cardiomyopathy

Septal myectomy – A surgical procedure that removes abnormally thick pieces of   the heart muscle.

Septal ablation – Rather than removing enlarged tissue surgically, this treatment destroys thickened heart tissues via an injection of alcohol.

Implantable cardioverter-defibrillator (ICD) – An ICD device is similar to a pacemaker, in that it is inserted into the heart and helps regulate the heart’s beating patterns.

Pacemaker implantation –  A pacemaker is an artificial device for stimulating the heart muscle and regulating its contractions.

Restrictive Cardiomyopathy

Restrictive cardiomyopathies are treated by addressing the disease’s underlying cause. In keeping with this approach, doctors may opt to use blood thinners, diuretics, heart rhythm medications and even chemotherapy and steroids.

Arrhythmogenic Right Ventricular Dysplasia

• Beta blockers
• Anti-arrhythmic drugs
• Implantable cardioverter-defibrillator (ICD)
• Catheter Ablation – This is a surgical procedure in which a catheter wire is used to find and burn away excessive tissues within the heart.