You Can Die from Cardiomyopathy

Cardiomyopathies

Cardiomyopathies: Group of chronic diseases of the heart muscle that lead to weak pumping of the heart (heart failure) and are usually treatable but not curable.

Dilated and hypertrophic cardiomyopathy are the most common forms. First of all, they lead to the symptoms of heart failure, but more threatening is sudden cardiac death, which can occur at any time due to heart failure. Treatment includes simple water tablets (diuretics), cardiac pacemaker support and heart transplantation, which in severe cases can only avert fatal heart failure.

Leading complaints

At the start:

  • Inefficiency and abnormal fatigue
  • Exertional air shortage
  • dizziness
  • Palpitations, irregular pulse
  • Increased urination at night
  • Swollen legs (edema).

In the advanced stage:

  • Severe shortness of breath, even at rest or even lying down
  • Chest pain (similar to angina pectoris)
  • Shortness of breath with rattling (water on the lungs, pulmonary edema)
  • Abdominal pain (from congestion of the liver).

When to the doctor

See a doctor or hospital immediately, if

  • You recognize signs that your cardiac output is suddenly declining - for example during a strenuous journey or after a workout.

The illness

to shape

Since the term "cardiomyopathy" encompasses a group of very different diseases, it is worth taking a look at the individual forms:

The key finding in the dilated cardiomyopathy (DCM) is the Extension, first of all the left ventricle, in the final stage of all other heart cavities as well. The heart contracts only weakly, its wall thickness is only slightly thicker. The most common causes are previous myocarditis or coronary artery disease. The prognosis for DCM is poor, the 10-year survival rate is only 20%. If medication does not improve the patient's condition enough, doctors often consider a heart transplant.

For the hypertrophic cardiomyopathy (HCM) is one thickening characteristic of the left ventricular musculature. This thickening restricts the flow of blood into the heart chamber. As a result, the atria expand or the mitral valve becomes leaky due to the increased working pressure.

  • If the thickening is asymmetrical and particularly affects the ventricular septum (25% of cases), there is an obstruction to outflow in the left ventricle (hypertrophic obstructive cardiomyopathy, HOCM). It is the leading cause of death among young competitive athletes; those affected are often symptom-free and the diagnosis is often only made by chance.
  • If the thickening is evenly distributed, there is no obstruction to outflow (hypertrophic non-obstructive cardiomyopathy, HNOCM, 75% of cases).

The rarer restrictive cardiomyopathy (RCM) is characterized by the reduced flexibility of the left ventricle, e.g. B. as a result of endocarditis. The chamber filling decreases, causing blood to back up in the pulmonary vessels.

In arrhythmogenic right ventricular cardiomyopathy (ARCM), which is also rarer, connective tissue cells with fat increasingly accumulate in the myocardial layer of the right ventricle. The right ventricle expands and can no longer pump blood to the lungs. In this context, cardiac arrhythmias are particularly life-threatening.

Above: Cross-section through the right and left ventricles in the forms of hypertrophic cardiomyopathy. Bottom middle: CT (view as in the diagram above) of a hypertrophic non-obstructive cardiomyopathy (HNOCM). Bottom: Chest X-ray of a dilated cardiomyopathy. In this patient, all of the heart cavities are enlarged.
Georg Thieme Verlag, Stuttgart

Causes and Risk Factors

Cardiomyopathies occur in all age groups, including children, pregnant women and (undetected) in competitive athletes. Men are affected twice as often as women. Cardiomyopathies often develop without a cause being found. Some of the cardiomyopathies are hereditary and result from mutations in the heart muscle cells, so they are more common in some families. Other known causes and risk factors include:

  • Alcohol abuse ("Bavarian Beer Heart")
  • high blood pressure
  • Heart attack, valvular heart disease, viral infections of the heart
  • Autoimmune diseases
  • Cardiotoxic drugs (e.g. doxorubicin)
  • Amyloidosis, M. Fabry.

As the list suggests, in some cardiomyopathies, such as the hereditary forms, the disease process is limited to the heart (primary cardiomyopathies), the more common secondary cardiomyopathies the heart muscle becomes ill as a result of another causal disease process.

Diagnostic assurance

During the physical examination, the doctor often notices a congestion of the neck veins. The heart usually beats quickly; when listening with the stethoscope, the doctor recognizes a so-called 3rd heart tone, and he often hears flow noises from the heart valves.

The most important examination method when a cardiomyopathy is suspected is echocardiography. With the help of this examination, the doctor can assess the muscle movements, the function of the heart valves and the pumping ability of the heart. To further clarify the cause, the doctor sometimes also arranges an MRI or a cardiac catheter examination, e.g. B. to obtain a heart muscle biopsy.

Cardiac arrhythmias show up in the ECG and especially in the long-term ECG. To assess the extent of heart failure, doctors use imaging techniques such as abdominal ultrasound or X-rays and laboratory tests such as the natriuretic peptide BNP (see heart failure).

treatment

The therapy depends on the type of cardiomyopathy and the severity of the symptoms.

Basic therapy

Treatment with catheter or surgery

In order to improve cardiac output and combat cardiac arrhythmias, doctors have a range of interventional and surgical procedures at their disposal:

  • Percutaneous coronary intervention (PCI) to remove constrictions in the coronary arteries
  • Heart valve surgery to treat heart valve defects (see acquired heart valve defects)
  • Transcoronary ablation of septal hypertrophy (TASH) in HOCM: Here the doctors inject alcohol into the coronary artery that supplies the thickened heart septum (septum), thus triggering an artificial infarction in this area. As a result, the muscle mass is reduced and the drainage from the chamber is free again
  • Myectomy, d. H. Surgical removal of the enlarged muscle mass in HCM with severe discharge disorders
  • Implanting a pacemaker (ICD)
  • Implantation of a biventricular pacemaker (two-chamber pacemaker). This tries to synchronize the temporally staggered beating heart chambers and thus to improve the heart function. This form of treatment is only offered in specialized heart centers
  • Heart transplant.

forecast

In the dilated Despite drug therapy, cardiomyopathy 20% of patients die within 10 years of diagnosis. The most common cause is cardiac arrhythmia.

The hypertrophic Cardiomyopathy is the leading cause of sudden cardiac death in young people.

Your pharmacy recommends

What you can do yourself

The most important rule is: find the right amount. On the one hand, this means finding the balance between necessary physical restraint and effective movement. Spare yourself no more than you have to and stay "in the middle of life". It is best to take part in one Cardiac sports group near you.

On the other hand, moderation concerns the issue of eating: obesity and alcohol are the deadly enemies of the already severely damaged heart muscle. Here moderation is a must. Many doctors also recommend a low-salt diet.

Otherwise, the same self-help recommendations apply as for heart failure.

Prevention

If a younger family member has had sudden cardiac death in your family, see a doctor to rule out hereditary cardiomyopathy.

Authors

Dr. med. Dieter Simon in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 15:20


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.