Living with
Cardiomyopathy

What is cardiomyopathy?

Cardiomyopathy refers to a collection of diseases that affect the heart muscle (myocardium), causing abnormal functioning of the heart.

The different causes of cardiomyopathy each have different symptoms, but they all eventually lead to the heart muscle becoming abnormally enlarged, too rigid and weak.

How could you know if you are in heart failure?

Depending on what type of cardiomyopathy you have, you may experience one or more of the following symptoms which can range in severity:

• Weakness and fatigue
• Shortness of breath (dyspnoea), especially during physical exertion
• Dizziness (vertigo) and fainting (syncope)
• Chest pain
• Heart palpitations and arrhythmias
• High blood pressure
• Oedema (swelling) in your feet, ankles or legs.

What causes cardiomyopathy?

The causes for cardiomyopathy include:

• Genetic disorders,
• Coronary artery disease
• Long-standing hypertension
• Diabetes
• Damage to the heart from previous heart attack
• Cancer treatment (chemotherapeutic drugs and/or radiation)
• Arrhythmias (particularly Atrial Fibrillation)
• Thyroid disease 
• Infectious or autoimmune illnesses or lifestyle factors such as obesity, recreational drug use and excessive and frequent alcohol consumption.

What are the different types of cardiomyopathy?

There are four different types of cardiomyopathy:

1. Dilated (congestive) cardiomyopathy: This is the most common form of cardiomyopathy and often occurs as a result of restricted blood flow to the heart muscle, usually as a result of atherosclerosis in coronary artery disease.
   It causes weakening and thinning of the heart walls, typically starting in the wall of the left ventricle, the main pumping chamber of the heart, gradually spreading to the rest of the chambers.
   When the heart walls become too thin, the actual heart chambers become dilated or “bloated”. Eventually, the heart beats with less force, ineffectively pumping blood to the rest of the body. This causes blood to pool in the heart’s chambers (congestion) which increases the risk of blood clots developing.
   Dilated cardiomyopathy mostly affects middle-aged men with coronary artery disease, but other causes include viral infection of the heart muscle and excessive alcohol consumption or recreational drug use. In rare cases it may be caused by pregnancy or connective tissue disorders such as rheumatoid arthritis. However, in most cases of dilated cardiomyopathy, the cause is unknown.
2. Hypertrophic cardiomyopathy (HCM): This occurs because the heart wall becomes thickened (hypertrophic) but weaker, making it harder for the heart to pump blood to the rest of the body.
   HCM can lead to arrhythmias and, in rare cases, sudden cardiac arrest during vigorous physical activity. HCM is usually an inherited or genetic disease. Although it can develop at any age, hypertrophic cardiomyopathy is usually more severe if diagnosed during childhood.
3. Restrictive cardiomyopathy: In this type of cardiomyopathy, the heart muscle becomes less elastic which prevents the heart from stretching properly. This limits the amount of blood that can fill the chambers of the heart.
   Restricted cardiomyopathy is very rare and mainly affects older people. It can be caused by other diseases such as haemochromatosis (the build-up of iron in the blood), amyloidosis (the build-up of the protein, amyloid, in the blood), sarcoidosis (the growth of granulomas or groups of inflammatory cells in organs or tissues) and some connective tissue disorders (such as caused by thyroid disease).
4. Arrhythmogenic right ventricular cardiomyopathy (ARVC) or arrhythmogenic right ventricular dysplasia (ARVD): This is a rare type of cardiomyopathy where the muscle in the wall of the right ventricle is replaced by fat or scar tissue, which interferes with normal heart rhythm.
   ARVC/D is a leading cause of sudden cardiac arrest among young people, particularly during physical activity, although it can occur at any age. It is often a result of genetic disorders.
   The most common symptoms of ARVC/D include palpitations and irregular arrhythmias with tachycardia, dizziness or fainting (syncope) and chest pain. You must consult a doctor immediately if you experience any of these symptoms, especially if someone in your immediate family has been diagnosed with ARVC/D.

Living and managing

If you have cardiomyopathy, it is important that of you limit your risk of other heart disease by following these healthy lifestyle guidelines:

1. Manage your blood pressure
   Keeping your blood pressure levels within healthy limits. To manage your blood pressure, limit your dietary salt intake.
   You can also access your own Cooking from the Heart Low Salt booklet, containing listed salt contents of South Africa’s most popular foods and nutrition brands. This booklet will ensure that you are never tricked by complicated, and often misleading, food labels again. Download it now for healthier cooking, shopping and snacking!
2. Eat a healthy diet low in fat and salt
   Read more about how to eat a heart-healthy, low-fat and low-salt diet.
   If your cholesterol levels are high even with a healthy diet, speak to doctor about medication to manage your cholesterol levels.
3. Exercise and try to maintain a healthy weight
   Try to keep as active as possible. You don’t have to join a gym do this; instead, just take regular walks, ride a bike or dance along to the music on your radio.
   Your goal should be 30 minutes of moderate activity (makes you sweat and your heart beat a little faster) most days of the week.
   Regular physical activity helps you manage your blood pressure and glucose levels, lose weight, and alleviate stress, thereby reducing the risk of heart disease.
4. Manage your diabetes
   Eating a healthy low-fat and low-sugar diet, exercising regularly and maintaining a healthy weight will all help you successfully manage your blood sugar levels.
   If your blood sugar levels are still above normal even with healthy diet and exercise, then speak to your doctor as you may need to take medication to manage your glucose levels.
5. Manage stress
   When you’re stressed, your heart rate and blood pressure go up – this is not good for your heart. Furthermore, you may not manage your blood pressure or other chronic conditions and forget to exercise, eat right or take your medicines when you are anxious.
   Find ways to relieve stress, such as practising meditation, mindfulness or yoga.
6. Stop smoking
   Talk to your doctor about ways to quit smoking, as tobacco smoke significantly increases your risk of heart disease.
7. Limit your alcohol consumption
   As excess alcohol consumption can cause cardiomyopathy and worsen the condition, you will need to speak to your doctor or healthcare provider about what amount of alcohol is appropriate for you to consume.
   Generally, to stay healthy, it is recommended that women not exceed one glass of alcohol per day, while men should have no more than two glasses per day.

What treatment is available for managing cardiomyopathy?

The treatment of cardiomyopathy depends on the cause and severity of heart damage present. While some treatments may be targeted at the underlying cause of the damage, most are aimed at improving the symptoms you experience as a result of abnormal heart function, including the following medications:

• ACE-inhibitors
• Beta-blockers or other anti-arrhythmic medications
• Anticoagulants

Sometimes, people may require surgical implantation of a pacemaker to regulate their heartbeat; however, in a small number of severe cases of cardiomyopathy, a heart transplant may be required.

What are the complications of cardiomyopathy?

Cardiomyopathy can cause heart failure, arrhythmias or cardiac arrest.