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Changing Lifestyles, Changing Habits: Living with Cardiomyopathy

separator Cardiomyopathy is a fairly rare heart condition, but it's a serious one. You may know it as "enlarged heart," which is how some people refer to it. Normally, the heart is just the right size, with just the right degree of flexibility in its tissue, to pump blood effectively throughout the body. In cases of cardiomyopathy, the heart muscle becomes inflamed and doesn't pump blood as well as it should.

Cardiomyopathy affects about 50,000 Americans, a relatively small number. But it's the leading reason for most heart transplants.

The condition takes three forms:

Hypertrophic: This form is almost always inherited, and it's the most rare of the three. Hypertrophic cardiomyopathy causes an abnormality in the growth and arrangement of the heart muscles. The heart walls become thickened, especially in the left ventricle. The blood flow and pumping ability of the heart are limited. Treatment can consist of lifestyle changes, such as reducing activity level; medication; pacemaker implantation and surgery.

Restrictive: This type of cardiomyopathy is rare in the U.S. It's typically caused when another illness, not related to the heart, eventually causes the walls of the heart's ventricles to stiffen. The heart loses its ability to pump blood effectively.

Dilated: We'll provide more details on this type of cardiomyopathy, since it's the most common form. It occurs most frequently in middle-aged people, and in more men than women. But the condition can affect people of all ages, even children. Dilated cardiomyopathy causes one or more chambers of the heart to become enlarged and stretched. Diseased heart muscle fibers cause this stretching and enlargement. The ability to pump blood effectively decreases, and the heart tries to make up for this pumping problem by enlarging even further.

What are the Causes?

In many cases, the cause of dilated cardiomyopathy is never determined. But there are some known causes:

  • Excessive alcohol use (especially harmful when combined with a poor diet)
  • Complication during pregnancy
  • Viral infections, which can lead to inflammation of the heart muscle
  • Heredity (this is a rare cause)

Symptoms of Cardiomyopathy

Cardiomyopathy itself often causes no symptoms at first, but the condition eventually causes the heart to become weaker and weaker. Heart failure is often the result. Symptoms of heart failure include:

  • Fatigue and weakness
  • Shortness of breath (this can be severe, and is sometimes accompanied by a cough)
  • Swelling of the hands and feet due to fluid accumulation, which may also affect the lungs
  • Abnormal weight gain

When dilated cardiomyopathy is in the advanced stages, there may be pain in the chest or abdomen. Some patients may develop irregular heartbeats, which can be life-threatening.

Diagnosis and Treatment

Dilated cardiomyopathy is typically diagnosed by performing the following tests:

  • X-ray to show whether the heart is enlarged
  • Electrocardiogram, which detects abnormal electrical activity in the heart
  • Echocardiogram, which uses sound waves to produce pictures of the heart

In most cases, doctors treat dilated cardiomyopathy in a combination of ways.

First, they eliminate any known causes, such as alcohol consumption. Patients also get information about foods to eat and foods to avoid. Often, salt is strictly limited.

Medications are often used as well. There are drugs that can help remove excess fluid, help the heart's pumping ability and regulate the heartbeat.

A mechanical pumping device, called a ventricular assist device (VAD), can be implanted. Initially, doctors used VADs to keep patients alive until a transplantable heart became available. But recent news has shown that VADs may be possible for long-term treatment of heart failure, and that they may be more effective than medication. (See the news article in this issue of the magazine for more information about the VAD.)

Heart transplants may become the best alternative if the patient isn't responding to other treatment.

Healthy Lifestyle and Regular Doctor Visits Important

The course that dilated cardiomyopathy takes can vary from person to person. Some people may not respond well to treatment, while others do extremely well for many years.

If you've been diagnosed with cardiomyopathy, or with heart failure, which often results, be sure to maintain regular visits with your doctor and the other members of your healthcare team. You may also want to consider joining a support group for people with heart failure. Getting advice and feedback about making dietary changes, getting the right amount of exercise, managing stress and taking medication regularly can be invaluable.

The American Heart Association; The National Heart, Lung, and Blood Institute; M. Silver. Success with Heart Failure. Insight Books/Plenum Publishing, New York, New York, 10013, 1998.
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