DEFINITION

Cardiomyopathy is a condition that causes abnormalities in the heart muscle. Cardiomyopathy may have no apparent cause (idiopathic primary Cardiomyopathy) or may be related to an underlying condition (secondary Cardiomyopathy). Cardiomyopathy is a leading cause of heart failure.

DESCRIPTION

There are three types of Cardiomyopathy: dilated (congestive), hypertrophic and restrictive.
Dilated (congestive) Cardiomyopathy
This is the most common form of Cardiomyopathy. The lower chambers of the heart (ventricles) dilate, causing the muscle wall to be stretched thin, like a blown-up balloon. This reduces the ability of the heart muscle to contract. The heart becomes weak, and arrhythmias may occur. The slow movement of blood through the heart increases the risks of developing a blood clot (thrombus). This form of Cardiomyopathy is most often caused by a related heart disease such as atherosclerosis. Other causes include infections, nutritional disorders, endocrine diseases such as diabetes or thyroid disease, morbid obesity, pregnancy and drugs or toxins.
Hypertrophic Cardiomyopathy
The muscle of the left ventricle, or the wall separating the chambers of the heart (septum) becomes abnormally thick. This leaves little space for blood to enter the heart chambers. The ventricles are stiff and resist filling, reducing the amount of blood leaving the heart with each contraction. The thickened walls may also distort the valve between the atrium and ventricles, causing a leak of blood between the two chambers. Most cases of hypertrophic Cardiomyopathy are caused by a congenital disorder. This type of Cardiomyopathy is the leading cause of sudden death in adolescents and children, which may occur before other symptoms have ever been noticed.
Restrictive Cardiomyopathy
This is the least common type of Cardiomyopathy. The ventricular muscles are infiltrated by fibrous tissue, causing them to become rigid and unable to fill properly. This is usually caused by rare disease processes such as amyloidosis or endomyocardial fibrosis.

SIGNS AND SYMPTOMS

Signs and symptoms are similar for all three types of Cardiomyopathy and include: fatigue; shortness of breath, worse on exertion; difficulty breathing when lying down; swollen legs and ankles; palpitations or angina (chest pain); dizziness or fainting and sudden death.

TREATMENT OPTIONS

Always consult your Doctor for diagnosis and advice.
- Cardiomyopathy is a serious medical condition which is a leading cause of death by heart failure. Careful management by a heart specialist (Cardiologist) can prolong life and reduce the risk of fatality.
- Your Doctor may arrange several tests to diagnose Cardiomyopathy, including blood tests, an electrocardiogram (ECG), a chest X-ray and an ultrasound of the heart (echocardiogram). A cardiac catheter may be inserted to view the chambers of the heart through a small tube and a biopsy of the heart muscle may be taken.
- The first aim of treatment is to identify and treat any underlying causes, such as infection, disease or alcoholism.
- In many cases there will be no treatable cause. Medications to reduce the workload of the heart and prevent blood clotting are usually prescribed.
- Gentle exercise is recommended, at a level that does not cause you to develop symptoms. Your Doctor can help you develop an appropriate exercise programme.
- Strenuous exercise must be avoided, as many sudden cardiac deaths occur during periods of exertion.
- Smoking and alcohol must be avoided.
- Follow a recommended diet.

PHARMACIST'S ADVICE

Ask your Pharmacist for advice.
1) See the Diet Hints. Avoiding foods that are high in fat and salt is very important.
2) It is vital to quit smoking. Smoking increases heart rate and blood pressure, and is a major risk factor for heart disease. Ask your Pharmacist for advice about anti-smoking products.
3) Alcohol must be kept to a minimum. Heavy drinking is associated with an increased risk of Cardiomyopathy.
4) Regular, gentle exercise helps to improve the health and strength of the heart.
5) Obesity is a serious risk factor for heart disease. Ask your Pharmacist for advice about weight loss.
6) Cholesterol levels should be monitored regularly.
7) Consider taking some nutritional supplements if the diet is inadequate.

DIET HINTS

Always follow the advice of your medical practitioner.
- Eat a wide variety of nutritious foods, including fruit, vegetables, wholegrains, lean meats and fish.
- Selenium deficiency is associated with Cardiomyopathy. It is found in fish, liver, kidneys, nuts and whole grains.
- Avoid saturated fats such as butter, cream, and full-fat dairy products such as milk, cheese and yoghurt. Use polyunsaturated and monounsaturated vegetable oil such as olive oil, and choose low-fat dairy products.
- Salt must be avoided as it raises the blood pressure. Season foods with pepper, ginger, garlic, fresh herbs, salt-free spices and lemon juice.
- Avoid alcohol and caffeine (tea, coffee, energy drinks) which raise the blood pressure and put greater strain on the heart muscle.

ORGANISATIONS and SUPPORT GROUPS

See the Heart Foundation of Australia topic on the Healthpoint.

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