CARDIOMYOPATHY: DIAGNOSIS AND TREATMENT
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
• Inflammatory Clinical Presentation Most cardiomyopathies are asymptomatic to begin with and symptoms develop in those with any type of heart failure. Symptoms include:
• Shortness of breath
• Paroxysmal Nocturnal Dyspnoea
The mortality rate increases by 10% each year for people who develop heart failure and is at 80% after eight years.
• 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
• Sudden death (rare) Arrhythmogenic Right Ventricular Cardiomyopathy
• 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:
● 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.
● 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.