Cardiomyopathy

Some people with cardiomyopathy never have any symptoms. Other people may not have symptoms until the condition gets worse. Common symptoms include the following:

• Shortness of breath
• Chest pain, especially after physical activity or heavy meals
• Swelling of the legs or abdomen
• Tiredness even after resting
• Dizziness and fainting
• Arrhythmias (irregular heartbeats)
• Heart murmurs (extra or unusual sounds heard during a heartbeat)
• Babies and young children may experience vomiting, diarrhea, difficulty eating and breathing, fussiness and poor growth

Call 911 if you are having trouble with breathing, swelling or any other unusual symptoms that last for a significant period. 

Cardiomyopathies can be inherited or acquired.

• “Acquired” means that you were not born with the disease, but you developed it due to another disease or condition. Conditions that damage your heart can lead to cardiomyopathy.
• “Inherited” means that your parents passed the gene for the disease on to you. Hypertrophic cardiomyopathy and arrhythmogenic cardiomyopathy are inherited types of the disease. Mutations or changes in the genes that control how your heart is formed during fetal development. 

Risk factors you can control:

• Drinking a lot of alcohol regularly (more than 2 drinks per day for men or 1 drink per day for women) places your heart at increased risk of weakening and enlarging.
• Major health problems and risk factors that can be treated and managed and if not, can contribute to developing severe coronary artery disease and heart attacks. These include tobacco use, obesity, hypertension, diabetes, high cholesterol, sedentary lifestyle, and high stress.  
• Very stressful situations, which can raise your risk of takotsubo cardiomyopathy, also called broken heart syndrome, especially if you have other risk factors.
• Using cocaine or amphetamines, or exposure to other potentially harmful toxins.

Risk factors you can’t control:

• Age: Some types of cardiomyopathies are more common in certain age groups and risk of coronary disease increases with age.
• Genetics: Both for specific genetic cardiomyopathies as well as for developing coronary disease and heart attacks which are the leading cause of dilated cardiomyopathy. In addition, risk factors like diabetes and hypertension that lead to coronary disease and heart attacks follow familial patterns.  
• Arrhythmogenic cardiomyopathy is more common in teens and young adults.
• Dilated cardiomyopathy is more common in adults between 20 and 60 years old.
• Hypertrophic cardiomyopathy due to genetic abnormalities is more common in people in their 30s.
• Takotsubo cardiomyopathy is more common in women after menopause.
• Family history of cardiomyopathy or other heart conditions
• Chemotherapy or radiation treatment for cancer

Medical conditions that increase your risk factor:

• Heart inflammation from endocarditis, myocarditis, or pericarditis
• Infections, such as viral hepatitis and HIV
• Obesity, diabetes or other problems with your metabolic system
• Thyroid disease and other problems with your hormone levels
• Rare diseases that affect how well your muscles work, such as Duchenne muscular dystrophy and those that cause abnormal substances to build up in your heart, such as sarcoidosis or amyloidosis 

Your doctor may screen you for cardiomyopathy if a close relative has this condition or has had another serious heart condition, or if people in your family have died suddenly presumed to be a result of cardiac arrest. Your doctor may also notice signs of cardiomyopathy during a routine exam.

Cardiomyopathy diagnostic tests

To diagnose cardiomyopathy, your doctor may order one or more tests:

• Blood tests: To check for substances that indicate heart failure or muscle damage.
• Imaging: Echocardiograms, MRI and CT scans provide images of the heart's structure and function.
• Cardiac catheterization: A catheter is inserted into the heart to measure pressure and obtain images of the coronary arteries.
• Genetic testing: To diagnose inherited cardiomyopathies.

Cardiomyopathy procedures

Your doctor may order one of these medical procedures to confirm your diagnosis:

• Echocardiography: A safe, non-invasive test using sound waves to visualize the heart’s structure and function. It’s often the first test ordered to assess heart abnormalities and can help identify the cause of cardiomyopathy.
• Cardiac catheterization: An invasive test where a catheter is inserted into a blood vessel and threaded into the heart to take images and measure pressure. This helps determine the cause of cardiomyopathy and guide treatment strategies.
• Coronary angiography: Performed during cardiac catheterization, this involves injecting contrast dye into the coronary arteries to detect blockages. If blockages are found, your doctor may perform angioplasty and stenting or recommend bypass surgery. While generally safe, risks include bleeding, infection or arrhythmias, especially in older patients or those with kidney disease or diabetes.
• Heart biopsy (myocardial biopsy): Rarely performed, this involves removing a small piece of heart tissue to check for specific causes of cardiomyopathy. It is typically done during cardiac catheterization.

Advanced imaging

Other imaging techniques can provide additional information to help diagnose whether a patient has a cardiomyopathy, as well as its underlying cause. These include CT scanning, MRI (Magnetic Resonance Imaging) and PET (Positron Emission Tomography). Typically, these tests will also use contrast agents or radioactive tracers (low enough dose to be very safe) to enhance imaging and make diagnosis more feasible and accurate.

You may be able to prevent acquired cardiomyopathy or help lower your risk of problems. Make heart-healthy lifestyle changes, such as choosing heart-healthy foods, being physically active, aiming for a healthy weight, quitting smoking and managing stress. Also, do not drink too much alcohol, and avoid illegal drugs such as cocaine.

• Get treatment for medical conditions that can cause cardiomyopathy or make your condition worse.
• There is no way to prevent inherited cardiomyopathy. However, you can take steps to prevent it from getting worse and to prevent serious health problems. 

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If you have cardiomyopathy, talk to your doctor about heart-healthy lifestyle changes and routine medical care that you may need to help you manage the disease. Your doctor may ask you to make lifelong changes. These can help manage any existing problems as well as prevent future complications.

• Aim for a healthy weight. Overweight and obesity can make your heart work harder.
• Choose heart-healthy foods. Your doctor may suggest choosing foods that are lower in sodium (salt) and fat. Talk with your doctor about the amounts and types of fluids that are safe and healthy for you. Too much fluid can make your symptoms worse.
• Get good-quality sleep. You may need to get tested for sleep disorders, such as sleep apnea, that can make your symptoms worse.
• Get regular physical activity. Ask your doctor what types and amounts of exercise are safe for you. This will depend on the type of cardiomyopathy that you have and whether you have any symptoms or problems.  
• Manage stress. Extreme stress can cause cardiomyopathy or trigger an irregular heartbeat.
• Quit smoking. Smoking raises your risk of other heart conditions that can make your cardiomyopathy worse.
• Limit your alcohol intake. For men, this is no more than two drinks a day, and one drink a day for women. Also, do not use illegal drugs.
• Cardiomyopathy often runs in families. Your parents, children, or brothers and sisters may also have this condition and may need to go to their doctors to get checked.

In severe cases, cardiomyopathies can cause major high-risk health problems that can affect the heart and brain.

• Heart failure: This serious condition happens when your heart doesn’t pump enough blood for your body’s needs.
• Arrhythmia (irregular heartbeat): Cardiomyopathy can affect the electrical signals in your heart that control your heart rate and rhythm.
• Heart valve disease: Cardiomyopathy can damage your heart valves, which are flaps of tissue in your heart that open and close with each heartbeat. Your heart vavles make sure that blood flows in the right direction through your heart's four chambers and to the rest of your body.  
• Stroke: Cardiomyopathy weakens the heart, making it hard to pump blood well. Blood can pool in the chambers of your heart and cause a blood clot. If a clot breaks off and travels to your brain, it can cause a life-threatening stroke.
• Cardiogenic shock: This is a life-threatening condition that occurs when your heart can’t pump enough blood and oxygen to your brain, kidneys, and other important organs.
• Cardiac arrest: Cardiomyopathy can cause your heart to stop beating suddenly and unexpectedly.

Learn the warning signs of stroke and how to help someone who is in cardiac arrest.

Call 911 right away if you think you or someone else is having a stroke, is in shock or suffering a sudden cardiac arrest.