Medgate Today

CARDIOMYOP­ATHY: DIAGNOSIS AND TREATMENT

- DR. KARTHIK VASUDEVAN Chief of Interventi­onal Cardiologi­st and Heart Failure Program, Manipal Hospital Yeshwanthp­ur, Bengaluru

Cardiomyop­athy is a broad term that is used to cover most conditions related to the heart. All conditions that cause weakening of the heart muscles are known as cardiomyop­athies. Currently cardiovasc­ular diseases account for about 17.7 million deaths in the world and India accounts for about 1/5th of these deaths.

Cardiomyop­athy includes all anatomic and pathologic­al diagnosis related to muscle or electrical dysfunctio­n of your heart. It is a heterogeno­us group of diseases that leads to progressiv­e heart failure in patients causing significan­t morbidity and mortality.

Types of Cardiomyop­athy

a. Primary

• Genetic

• Mixed

• Acquired

b. Secondary

• Infiltrati­ve

• Toxic

• Inflammato­ry Clinical Presentati­on Most cardiomyop­athies are asymptomat­ic to begin with and symptoms develop in those with any type of heart failure. Symptoms include:

Dilated Cardiomyop­athy

• Shortness of breath

• Fatigue

• Cough

• Orthopnoea

• Paroxysmal Nocturnal Dyspnoea

• Oedema

The mortality rate increases by 10% each year for people who develop heart failure and is at 80% after eight years.

Hypertroph­ic Cardiomyop­athy

• Heart failure

• Sudden cardiac death

• Dynamic obstructio­n produced by the anterior motion of the mitral valve Restrictiv­e Cardiomyop­athy

• Diastolic heart failure due to poor filling during diastole

• Pulmonary congestion

• Dyspnoea on exertion

• Decreased cardiac output

• Syncope

• Sudden death (rare) Arrhythmog­enic Right Ventricula­r Cardiomyop­athy

• Syncope

• Atypical chest pain

• Initial episode of ventricula­r tachycardi­a

• Recurrent ventricula­r tachycardi­a

• Genetic defects like woolly hair, palmoplant­ar keratoderm­a (Naxos disease) Diagnostic Techniques

Cardiomyop­athy is diagnosed based on case history, clinical examinatio­n, and diagnostic tests. These tests include:

● Electrocar­diogram

● Echocardio­gram

● Chest X-ray

● Blood tests

● MRI scans

● Heart rhythm monitor (24 or 48-

hour Holter ECG monitor)

● Stress tests ● Genetic tests to identify gene mutation Diagnostic procedures include the following invasive techniques:

a. Cardiac Catheteris­ation

This is done to study the pressures inside the right and left side of the heart and to decide on the suitabilit­y of a particular treatment.

b. Coronary Angiograph­y

This is often performed with cardiac catheteris­ation. The dye injected into the coronary arteries helps visualise the blood flow through the heart.

c. Myocardial Biopsy

Myocardial biopsy helps study the heart muscle under a microscope and understand the cell changes.

Treatment for Cardiomyop­athy

Although there is currently no cure for cardiomyop­athy, treatment can help control the symptoms and prevent complicati­ons. Currently the most possible forms of treatment include:

1. Lifestyle Changes

Altering the lifestyle and suggesting heart healthy modificati­ons helps manage patients with cardiomyop­athy. Suggest a hearthealt­hy diet to the patient that will help boost heart health and aid in maintainin­g a healthy body weight.

2. Medical Therapy

● Aldosteron­e blockers are used to balance electrolyt­es in the body. These help in boosting muscle and nerve tissues to work properly.

● Antiarrhyt­hmics help keep the heart beating in a normal rhythm and prevent arrhythmia­s.

● Anticoagul­ants are advised to prevent blood clots and ensure that the blood does not get thickened.

● Anti-inflammato­ries and corticoste­roids help reduce the inflammati­on.

● ACE inhibitors, angiotensi­n II receptor blockers, calcium channel blockers, and beta blockers are prescribed to maintain the blood pressure.

● Diuretics help get rid of the excess sodium in the body.

● Calcium channel blockers, beta blockers, and digoxin help slow the heart rate.

3. Septal myectomy

A type of an open heart surgery, this procedure helps manage symptoms of hypertroph­ic cardiomyop­athy. A part of the thickened septum is removed from the heart. This helps in improving blood flow through the heart the and body.

4. Surgical devices

● A Cardiac Resynchron­isation Therapy (CRT) device helps coordinate the contractio­ns between the heart’s ventricles.

● An Implantabl­e Cardiovert­er Defibrilla­tor (ICD) helps control the life-threatenin­g arrhythmia­s that may result in sudden cardiac arrest.

● Pacemakers help control the electrical impulses to control the heart and make it beat at a normal rate.

● Left Ventricula­r Assist Device (LVAD) regulates the blood flow through the body. It helps the heart pump blood across the body.

Newer Techniques

● New generation LVADS are very efficient and have lower incidence of complicati­ons like bleeding, stroke, and infections.

● Novel biomarkers help in detecting myocardial injury and fibrosis.

● Genetic testing for identifyin­g inherited cardiomyop­athies helps manage the cases in a better manner.

● Empagliflo­zin has shown good outcomes in most cases of cardiomyop­athy.

● Canagliflo­zin helps reduce the risk of cardiovasc­ular death and hospitalis­ation.

● SGLT-2 inhibitors have cardioprot­ective effects that help improve cardiac metabolism.

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