ABOUT CARDIOMYOPATHY

Cardiomyopathy means disease of the heart muscle. Cardiomyopathy damages the muscle tone of the heart and reduces its ability to pump blood to the rest of the body.

Cardiomyopathy is dangerous because it often goes unrecognized and is untreated. It is also different from other heart problems because it often affects younger people and often results in sudden death.

Dilated Cardiomyopathy is the most common form of the disease. It affects the chambers of the heart by weakening their walls. In about 80% of cases doctors do not know the cause. This type of cardiomyopathy is called IDIOPATHIC DC ("disease of unknown cause characterized by dilation and impaired function of one or both heart ventricles.")

Dilated cardiomyopathy (DCM) is a disease of the heart muscle that causes the heart to become enlarged and to pump less strongly . The reasons why the heart muscle weakens are uncertain, but the process is probably slow and only presents with symptoms when quite advanced.

As a result the muscle of the heart becomes weak, thin, or floppy and is unable to pump blood efficiently around the body. This causes fluid to build up in the lungs, which therefore become congested, and results in a feeling of breathlessness: this is called left heart failure

Often there is also right heart failure, which causes fluid to accumulate in the tissues and organs of the body, usually the legs and ankles, and the liver and abdomen.

There are other causes of a dilated heart, including common diseases like coronary heart disease, high blood pressure (hypertension) and heart valve disease. These can also cause heart failure like DCM, and here the doctor needs to treat the underlying cause as well as the heart failure. In DCM, by definition, all these other causes have been ruled out, and the disease is caused by an intrinsic heart muscle problem.

Symptoms include tiredness and shortness of breath while exercising or resting. Sufferers may also have heart palpitations and notice their ankles becoming swollen.

Although it's not entirely clear why people develop Dilated Cariomyopathy, there are a number possible reasons. It may follow a viral or other infection of the heart, for example, or be part of an autoimmune process where for an unknown reason the body attacks itself. Certainly, alcohol and drug misuse can cause the problem and in some cases it runs in families.

Hypertrophic Cardiomyopathy is the second most common form of the disease. It is usually an inherited disease that causes a thickening of the hearts walls.

The main feature of HCM is an excessive thickening of the heart muscle (hypertrophy literally means to thicken) in the absence of an apparent cause. Heart muscle may thicken in normal individuals as a result of high blood pressure or prolonged athletic training. In HCM, however, the muscle thickening occurs without obvious cause.

In addition, microscopic examination of the heart muscle shows that it is abnormal. The normal alignment of muscle cells is absent and this abnormality is called myocardial disarray. See diagram below.

Sufferers may become short of breath, suffer chest pains and palpitations, and may often faint. Tragically, sudden death is sometimes the first indication that Hypertrophic Cardiomyopathy was present.

Approximately one person in 500 has Hypertrophic Cardiomyopathy. Its exact cause is unknown, although it's usually inherited. Screening is offered to families of those with the condition.

Restrictive Cardiomyopathy is rare, it gets it name because the condition restricts the heart from stretching properly, which limits the amount of blood that can fill the chambers of the heart. In the UK, the most common cause is a condition called amyloid, where abnormal proteins are deposited in parts of the body, in this case the heart muscle.

Restrictive cardiomyopathy is a disorder of the heart muscle in which the walls of the ventricles become stiff, but not necessarily thickened, so they resist normal filling with blood. There is no cure. Treatment aims to relieve symptoms caused by the backup of blood into the lungs and veins of the neck and liver.

The least common of the cardiomyopathies, restrictive cardiomyopathy (RCM) can be idiopathic (its cause isunknown) or secondary to a number of rare cardiac and systemic disorders such as endomyocardial fibrosis (tropical, hypereosinophic syndrome), infiltrative disorders (amyloidosis, sarcoidosis), and rare metabolic disorders (Gaucher's disease, Mucopolysaccharidoses, Fabry's disease, carcinoid syndrome).

Restrictive cardiomyopathy is also described following radiation therapy for some types of cancer.

Patients with the idiopathic form may have a family history of cardiomyopathy. Recent evidence suggests that the disease may be caused by the same genetic abnormalities that result in the more common hypertrophic cardiomyopathy (HCM).

Ischaemic Cardiomyopathy is the weakening of the heart muscle tissue that results from coronary disease or heart attacks. Treatment for this type of cardiomyopthy is similar to that for other forms of cardiomyopathy, with special attention given to coronary artery disease.

Peripartum Cardiomyopathy is a rare disorder in which a weakened heart is diagnosed within the last month of pregnancy or within 5 months after delivery, without other identifiable causes for dysfunction of the heart. The heart muscle becomes enlarged and weakened and cannot pump blood efficiently. Decreased heart function affects the lungs, liver, and other body system

Most people with symptoms related to problems with their heart function will have an electrocardiogram, chest x-ray and echocardiogram, which allows the structure and function of the heart to be studied. From these tests the diagnosis of cardiomyopathy is made.

Medication to help the heart work better and therefore relieve the symptoms tends to work well for many people. Those with Hypertrophic Cardiomyopathy are sometimes offered surgery to remove parts of the thickened heart muscle.

When the symptoms of cardiomyopathy aren't well controlled by medication and a person's quality of life is affected, heart transplantation may be considered.

Check your family's medical for heart related problems. Learn about how to recognize the warning signs of the disease: shortness of breath, bloating, fainting, or chest pains. If you have any of these symptoms go and see your doctor as soon as you can. Don't drink to much alcohol, eat foods with the right vitamins in it, keep away from fatty foods, and adopt a healthy way of life. REMEMBER prevention is better than a cure.

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