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Symptoms and Signs of Cardiomyopathy

Doctor's Notes on Cardiomyopathy

Cardiomyopathy is when the heart muscle cannot contract or function normally that causes the heart to be weak and not able to pump blood adequately to the body. Signs and symptoms of cardiomyopathy may start with weakness and fatigue and exercise intolerance; shortness of breath and/or chest pain usually occur as the heart muscle function decreases. Swelling of the feet, ankles and legs frequently occurs. Some individuals may have electrical disturbances with cardiomyopathy; symptoms can be the same as above but can include palpitations, feelings of the heart skipping a beat or potentially fatal heart rhythms like ventricular fibrillation may happen.

Unfortunately, there are many causes of cardiomyopathy (at least 30, and many are due to other medical problems). However, any condition or disease that affects heart muscle so that it cannot supply the needed blood for the body’s demand can cause cardiomyopathy. A few examples that are common include genetic diseases, infections, toxins like alcohol abuse or lead, diabetes, hypertension, hypertrophy (thickened ventricle), neuromuscular disorders and many others.

Medical Author:
Medically Reviewed on 3/11/2019

Cardiomyopathy Symptoms

When the heart fails to contract properly oxygenated blood is not pumped adequately to the tissues and organs of the body. This inability to deliver oxygen to body tissues can lead to generalized weakness and fatigue. Other symptoms may include shortness of breath on exertion or chest pain.

If there is an electrical rhythm disturbance associated with the cardiomyopathy, abnormal heartbeats may cause palpitations and the sensation of an occasional skipped heart beat or lethal heart rhythms, such as ventricular fibrillation.

Over a period of time, cardiomyopathy can lead to significant decrease in ejection fraction and cardiac output leading to heart failure. Symptoms may include increasing shortness of breath and swelling of the feet, ankles, and legs.

Cardiomyopathy Causes

Some of the causes are of primary cardiomyopathy are:

Some of the causes are of primary cardiomyopathy are:

  • Genetic
    • Hypertrophic cardiomyopathy
    • Ion conduction abnormalities
      • Prolonged QT syndrome
      • Brugada syndrome
  • Mixed
    • dilated cardiomyopathy
    • restrictive cardiomyopathy
  • Acquired
    • inflammatory myocarditis
    • peripartum
    • physically and physiologically stress induced (tako-tsubo syndrome or "broken heart syndrome")

There are many causes of cardiomyopathy that can be categorized in several ways. One method of defining cardiomyopathy is based on the official definition by the American Heart Association (see below), which are broken into two categories, primary and secondary. Another method of categorizing cardiomyopathy causes are extrinsic and intrinsic (which are more commonly used when discussing the disease with patients, family, and caregivers) and are discussed later in this article.

The official definition of cardiomyopathy of the American Heart Association in 2006 is as follows:

"Cardiomyopathies are a heterogeneous group of diseases of the myocardium associated with mechanical and/or electrical dysfunction that usually (but not invariably) exhibit inappropriate ventricular hypertrophy or dilatation and are due to a variety of causes that frequently are genetic. Cardiomyopathies either are confined to the heart or are part of generalized systemic disorders, which may lead to cardiovascular death or progressive heart failure-related disability."

The definition divides heart disease into:

  • Primary cardiomyopathies, those that usually affect the heart alone (primary). The primary cardiomyopathies are further divided into inherited (genetic) diseases, those that are acquired, and those that are a combination of both. , and
  • Secondary cardiomyopathies, those that are a result of an underlying condition affecting many areas of the body.

There are many causes of cardiomyopathy that can be categorized in several ways. One method of defining cardiomyopathy is based on the official definition by the American Heart Association (see below), which are broken into two categories, primary and secondary. Another method of categorizing cardiomyopathy causes are extrinsic and intrinsic (which are more commonly used when discussing the disease with patients, family, and caregivers) and are discussed later in this article.

The official definition of cardiomyopathy of the American Heart Association in 2006 is as follows:

"Cardiomyopathies are a heterogeneous group of diseases of the myocardium associated with mechanical and/or electrical dysfunction that usually (but not invariably) exhibit inappropriate ventricular hypertrophy or dilatation and are due to a variety of causes that frequently are genetic. Cardiomyopathies either are confined to the heart or are part of generalized systemic disorders, which may lead to cardiovascular death or progressive heart failure-related disability."

The definition divides heart disease into:

  • Primary cardiomyopathies, those that usually affect the heart alone (primary). The primary cardiomyopathies are further divided into inherited (genetic) diseases, those that are acquired, and those that are a combination of both. , and
  • Secondary cardiomyopathies, those that are a result of an underlying condition affecting many areas of the body.

As previously mentioned, another method of categorizing cardiomyopathy causes are extrinsic and intrinsic (which are more commonly used when discussing the disease with patients, family, and caregivers). Extrinsic and intrinsic causes of cardiomyopathies are discussed below.

  • Extrinsic cardiomyopathies: Extrinsic cardiomyopathies are those that are due to diseases that are not uniquely due to heart muscle cell abnormalities
  • Intrinsic cardiomyopathies: Intrinsic cardiomyopathies are due to abnormalities that originate in the heart muscle cell.

Extrinsic cardiomyopathies

Examples of extrinsic cardiomyopathies include:

  • Ischemic cardiomyopathy is a disease of heart muscle due to inadequate blood supply to heart muscle and is a common cause of cardiomyopathy. When blood vessels to heart muscle become blocked, heart muscle cells can be deprived of oxygen and fail to function normally. An example of this is a heart attack, where a complete blockage of a blood vessel causes muscle cells to die, decreases the total amount of muscle that can contract and cardiac output is compromised.
  • Poorly controlled high blood pressure (hypertension) can lead to abnormally functioning heart muscle.
  • Diabetes
  • Alcohol abuse

Intrinsic cardiomyopathies

Examples of extrinsic cardiomyopathies include:

  • Amyloidosis can infiltrate heart cells with amyloid protein.
  • Sarcoidosis can cause heart cell inflammation.
  • Viral infections may cause inflammation of heart muscle (myocarditis) with temporary or potentially permanent damage to heart muscles cells leading to a secondary cardiomyopathy.
  • Dilated cardiomyopathies occur when the heart muscle fibers are abnormally stretched when the heart chambers increase in size and volume. The stretched muscles lose their ability to contract strongly, similar to a slinky or an elastic band that has been overstretched and loses its shape and function. As the heart walls continue to stretch, they can also cause damage to the heart valves between the chambers of the heart causing blood to regurgitate or backwash, and as a result there is decreased cardiac output and heart failure. There are many causes of dilated cardiomyopathy including:
    • infection,
    • alcohol,
    • cancer therapies,
    • chemical poisonings (for example, lead and arsenic),
    • neuromuscular disorders such as muscular dystrophy, and
    • a variety of genetic diseases.
  • Hypertrophic cardiomyopathy is a genetic or familial disease where muscle in the left ventricle has a predisposition to thicken and prevent normal flow of blood out of the heart. Hypertrophic cardiomyopathy is the most common cause of sudden death in young people, such as exercising athletes.
  • Peripartum cardiomyopathy is seen late in the third trimester of pregnancy, though it can continue to be a potential cause of cardiomyopathy for five months post-partum. It is more common in obese older pregnant women who develop preeclampsia.

As previously mentioned, another method of categorizing cardiomyopathy causes are extrinsic and intrinsic (which are more commonly used when discussing the disease with patients, family, and caregivers). Extrinsic and intrinsic causes of cardiomyopathies are discussed below.

  • Extrinsic cardiomyopathies: Extrinsic cardiomyopathies are those that are due to diseases that are not uniquely due to heart muscle cell abnormalities
  • Intrinsic cardiomyopathies: Intrinsic cardiomyopathies are due to abnormalities that originate in the heart muscle cell.

Extrinsic cardiomyopathies

Examples of extrinsic cardiomyopathies include:

  • Ischemic cardiomyopathy is a disease of heart muscle due to inadequate blood supply to heart muscle and is a common cause of cardiomyopathy. When blood vessels to heart muscle become blocked, heart muscle cells can be deprived of oxygen and fail to function normally. An example of this is a heart attack, where a complete blockage of a blood vessel causes muscle cells to die, decreases the total amount of muscle that can contract and cardiac output is compromised.
  • Poorly controlled high blood pressure (hypertension) can lead to abnormally functioning heart muscle.
  • Diabetes
  • Alcohol abuse

Intrinsic cardiomyopathies

Examples of extrinsic cardiomyopathies include:

  • Amyloidosis can infiltrate heart cells with amyloid protein.
  • Sarcoidosis can cause heart cell inflammation.
  • Viral infections may cause inflammation of heart muscle (myocarditis) with temporary or potentially permanent damage to heart muscles cells leading to a secondary cardiomyopathy.
  • Dilated cardiomyopathies occur when the heart muscle fibers are abnormally stretched when the heart chambers increase in size and volume. The stretched muscles lose their ability to contract strongly, similar to a slinky or an elastic band that has been overstretched and loses its shape and function. As the heart walls continue to stretch, they can also cause damage to the heart valves between the chambers of the heart causing blood to regurgitate or backwash, and as a result there is decreased cardiac output and heart failure. There are many causes of dilated cardiomyopathy including:
    • infection,
    • alcohol,
    • cancer therapies,
    • chemical poisonings (for example, lead and arsenic),
    • neuromuscular disorders such as muscular dystrophy, and
    • a variety of genetic diseases.
  • Hypertrophic cardiomyopathy is a genetic or familial disease where muscle in the left ventricle has a predisposition to thicken and prevent normal flow of blood out of the heart. Hypertrophic cardiomyopathy is the most common cause of sudden death in young people, such as exercising athletes.
  • Peripartum cardiomyopathy is seen late in the third trimester of pregnancy, though it can continue to be a potential cause of cardiomyopathy for five months post-partum. It is more common in obese older pregnant women who develop preeclampsia.

Heart Disease Symptoms, Signs, and Causes Slideshow

Heart Disease Symptoms, Signs, and Causes Slideshow

The heart is the hardest working muscle in the body. The average heart beats 100,000 times a day, day and night, to supply oxygen and nutrients throughout the body. Blood pumped by the heart also shuttles waste products such as carbon dioxide to the lungs so it can be eliminated from the body. Proper heart function is essential to support life.

REFERENCE:

Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.

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