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Cardiomyopathy is a group of diseases that affect the
heart muscle Cardiac muscle (also called heart muscle or myocardium) is one of three types of vertebrate Vertebrates () comprise all species of animal Animals (also called Metazoa) are multicellular eukaryotic organisms that form the Kingdom (biolo ...
. Early on there may be few or no symptoms. As the disease worsens,
shortness of breath Shortness of breath (SOB), also known as dyspnea (BrE British English (BrE) is the standard dialect A standard language (also standard variety, standard dialect, and standard) is a language variety that has undergone substantial codificat ...
, feeling tired, and swelling of the legs may occur, due to the onset of
heart failure Heart failure (HF), also known as congestive heart failure (CHF) and (congestive) cardiac failure (CCF), is a set of manifestations caused by the failure of the heart The heart is a cardiac muscle, muscular Organ (biology), organ in mo ...
. An irregular heart beat and
fainting Syncope, commonly known as fainting, is a loss of consciousness Consciousness, at its simplest, is or of internal and external existence. Despite millennia of analyses, definitions, explanations and debates by philosophers and scienti ...
may occur. Those affected are at an increased risk of
sudden cardiac death Cardiac arrest is a sudden loss of blood flow resulting from the failure of the heart The heart is a muscle, muscular Organ (anatomy), organ in most animals, which pumps blood through the blood vessels of the circulatory system. The pump ...
. Types of cardiomyopathy include
hypertrophic cardiomyopathy Hypertrophic cardiomyopathy (HCM) is a condition in which the heart becomes hypertrophy, thickened without an obvious cause. The parts of the heart most commonly affected are the interventricular septum and the ventricles. This results in the hea ...
,
dilated cardiomyopathy Dilated cardiomyopathy (DCM) is a condition in which the Cardiomegaly, heart becomes enlarged and cannot pump blood effectively. Symptoms vary from none to feeling tired, pedal edema, leg swelling, and shortness of breath. It may also result in che ...
,
restrictive cardiomyopathy Restrictive cardiomyopathy (RCM) is a form of cardiomyopathy Cardiomyopathy is a group of diseases that affect the heart muscle Cardiac muscle (also called heart muscle or myocardium) is one of three types of vertebrate Vertebrates () comp ...

restrictive cardiomyopathy
,
arrhythmogenic right ventricular dysplasia Arrhythmogenic cardiomyopathy (ACM), arrhythmogenic right ventricular dysplasia (ARVD), or arrhythmogenic right ventricular cardiomyopathy (ARVC), is an inherited heart disease. ACM is caused by Genetic disorder, genetic defects of the parts of ...
, and Takotsubo cardiomyopathy (broken heart syndrome). In hypertrophic cardiomyopathy the heart muscle enlarges and thickens. In dilated cardiomyopathy the ventricles enlarge and weaken. In restrictive cardiomyopathy the ventricle stiffens. In many cases, the cause cannot be determined. Hypertrophic cardiomyopathy is usually , whereas dilated cardiomyopathy is inherited in about one third of cases. Dilated cardiomyopathy may also result from
alcohol In chemistry, alcohol is an organic compound that carries at least one hydroxyl functional group (−OH) bound to a Saturated and unsaturated compounds, saturated carbon atom. The term alcohol originally referred to the primary alcohol ethan ...
,
heavy metals upright=1.2, Crystals of osmium, a heavy metal nearly twice as dense as lead">lead.html" ;"title="osmium, a heavy metal nearly twice as dense as lead">osmium, a heavy metal nearly twice as dense as lead Heavy metals are generally defined as ...
,
coronary artery disease Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), or simply heart disease, involves the reduction of blood flow to the heart muscle Cardiac muscle (also called heart muscle or myocardium) i ...
,
cocaine Cocaine (from , from , ultimately from Quechuan languages, Quechua: ''kúka'') is a tropane alkaloid and stimulant drug obtained primarily from the leaves of two coca species native to South America, ''Erythroxylum coca'' and ''Erythroxylu ...

cocaine
use, and
viral infections A viral disease (or viral infection) occurs when an organism's body is invaded by pathogenic viruses, and infection, infectious virus particles (virions) attach to and enter susceptible cells. Structural characteristics Basic structural charact ...
. Restrictive cardiomyopathy may be caused by
amyloidosis Amyloidosis is a group of diseases in which abnormal protein Proteins are large biomolecule , showing alpha helices, represented by ribbons. This poten was the first to have its suckture solved by X-ray crystallography by Max Perutz and ...

amyloidosis
,
hemochromatosis Iron overload or haemochromatosis (also spelled ''hemochromatosis'' in American English American English (AmE, AE, AmEng, USEng, en-US), sometimes called United States English or U.S. English, is the set of variety (linguistics), varietie ...
, and some
cancer treatment Cancer Cancer is a group of diseases A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not due to any immediate external injury. Diseases a ...
s.
Broken heart syndrome Broken may refer to: Literature * Broken (Armstrong novel), ''Broken'' (Armstrong novel), a 2006 novel by Kelley Armstrong in the ''Women of the Otherworld'' series * Broken (Slaughter novel), ''Broken'' (Slaughter novel), a 2010 novel by Kari ...
is caused by extreme emotional or physical stress. Treatment depends on the type of cardiomyopathy and the severity of symptoms. Treatments may include lifestyle changes, medications, or surgery. Surgery may include a
ventricular assist device A ventricular assist device (VAD) is an electromechanics, electromechanical device for assisting cardiac circulation, which is used either to partially or to completely replace the function of a failing heart. The function of VADs is different fro ...

ventricular assist device
or
heart transplant A heart transplant, or a cardiac transplant, is a surgical transplant procedure performed on patients with end-stage heart failure Heart failure (HF), also known as congestive heart failure (CHF), (congestive) cardiac failure (CCF), and decomp ...

heart transplant
. In 2015 cardiomyopathy and
myocarditis Myocarditis, also known as inflammatory cardiomyopathy, is inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogen In biology Biology is the na ...
affected 2.5 million people. Hypertrophic cardiomyopathy affects about 1 in 500 people while dilated cardiomyopathy affects 1 in 2,500. They resulted in 354,000 deaths up from 294,000 in 1990. Arrhythmogenic right ventricular dysplasia is more common in young people.


Signs and symptoms

Symptoms of cardiomyopathies may include fatigue, swelling of the lower extremities and
shortness of breath Shortness of breath (SOB), also known as dyspnea (BrE British English (BrE) is the standard dialect A standard language (also standard variety, standard dialect, and standard) is a language variety that has undergone substantial codificat ...
after exertion. Additional symptoms of the condition may include
arrhythmia Arrhythmia, also known as cardiac arrhythmia or heart arrhythmia, is a group of conditions in which the heartbeat Heartbeat or heartbeats may refer to: Physiology *Cardiac cycle, of the heart *Contraction of the cardiac muscle, muscles of the ...
, fainting, and dizziness.


Causes

Cardiomyopathies are either confined to the heart or are part of a generalized systemic disorder, both often leading to cardiovascular death or progressive heart failure-related disability. Other diseases that cause heart muscle dysfunction are excluded, such as
coronary artery disease Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), or simply heart disease, involves the reduction of blood flow to the heart muscle Cardiac muscle (also called heart muscle or myocardium) i ...
,
hypertension Hypertension (HTN or HT), also known as high blood pressure (HBP), is a Chronic condition, long-term Disease, medical condition in which the blood pressure in the artery, arteries is persistently elevated. High blood pressure usually does not ...

hypertension
, or abnormalities of the
heart valves A heart valve is a one-way valve check valve Image:Check Valve.svg, 140px, Check valve symbol on piping and instrumentation diagrams. The arrow shows the flow direction. A check valve, non-return valve, reflux valve, retention valve, foot valv ...

heart valves
. Often, the underlying cause remains unknown, but in many cases the cause may be identifiable. Alcoholism, for example, has been identified as a cause of dilated cardiomyopathy, as has drug toxicity, and certain infections (including
Hepatitis C Hepatitis C is an infectious disease caused by the hepatitis C virus (HCV) that primarily affects the liver; it is a type of viral hepatitis. During the initial infection people often have mild or no symptoms. Occasionally a fever, dark urine, a ...

Hepatitis C
). Untreated
celiac disease Coeliac disease or celiac disease is a long-term autoimmune disorder An autoimmune disease is a condition arising from an abnormal immune response to a functioning body part. There are at least 80 types of autoimmune diseases. Nearly any bo ...
can cause cardiomyopathies, which can completely reverse with a timely diagnosis. In addition to acquired causes, molecular biology and genetics have given rise to the recognition of various genetic causes. A more clinical categorization of cardiomyopathy as 'hypertrophied', 'dilated', or 'restrictive', has become difficult to maintain because some of the conditions could fulfill more than one of those three categories at any particular stage of their development. The current
American Heart Association The American Heart Association (AHA) is a nonprofit organization A nonprofit organization (NPO), also known as a non-business entity, not-for-profit organization, or nonprofit institution, is a legal entity organized and operated for a collectiv ...
definition divides cardiomyopathies into primary, which affect the heart alone, and secondary, which are the result of illness affecting other parts of the body. These categories are further broken down into subgroups which incorporate new genetic and molecular biology knowledge.


Mechanism

The pathophysiology of cardiomyopathies is better understood at the cellular level with advances in molecular techniques. Mutant proteins can disturb cardiac function in the contractile apparatus (or mechanosensitive complexes). Cardiomyocyte alterations and their persistent responses at the cellular level cause changes that are correlated with sudden cardiac death and other cardiac problems.


Diagnosis

175 px, Normal sinus rhythm/EKG Among the diagnostic procedures done to determine a cardiomyopathy are: * Physical exam * Family history *
Blood test A blood test is a laboratory A laboratory (; ; colloquially lab) is a facility that provides controlled conditions in which or technological research, s, and may be performed. Laboratory services are provided in a variety of settings: ...

Blood test
*
ECG Electrocardiography is the process of producing an electrocardiogram (ECG or EKG). It is an electrogram of the heart The heart is a cardiac muscle, muscular Organ (biology), organ in most animals, which pumps blood through the blood ...

ECG
*
Echocardiogram An echocardiography, echocardiogram, cardiac echo or simply an echo, is an Medical ultrasound, ultrasound of the heart. It is a type of medical imaging of the heart, using standard ultrasound or Doppler echocardiography, Doppler ultrasound. Echoc ...

Echocardiogram
* Stress test *
Genetic testing Genetic testing, also known as DNA testing, is used to identify changes in DNA Deoxyribonucleic acid (; DNA) is a molecule File:Pentacene on Ni(111) STM.jpg, A scanning tunneling microscopy image of pentacene molecules, which consist o ...


Classification

Cardiomyopathies can be classified using different criteria: * Primary/intrinsic cardiomyopathies ** Genetic ***
Hypertrophic cardiomyopathy Hypertrophic cardiomyopathy (HCM) is a condition in which the heart becomes hypertrophy, thickened without an obvious cause. The parts of the heart most commonly affected are the interventricular septum and the ventricles. This results in the hea ...
(HCM) ***
Arrhythmogenic right ventricular cardiomyopathy Arrhythmogenic cardiomyopathy (ACM), arrhythmogenic right ventricular dysplasia (ARVD), or arrhythmogenic right ventricular cardiomyopathy (ARVC), is an inherited heart disease. ACM is caused by Genetic disorder, genetic defects of the parts of ...

Arrhythmogenic right ventricular cardiomyopathy
(ARVC) *** LV non-compaction *** Ion Channelopathies ***
Dilated cardiomyopathy #REDIRECT Dilated cardiomyopathy Dilated cardiomyopathy (DCM) is a condition in which the Cardiomegaly, heart becomes enlarged and cannot pump blood effectively. Symptoms vary from none to feeling tired, pedal edema, leg swelling, and shortness of ...
(DCM) ***
Restrictive cardiomyopathy Restrictive cardiomyopathy (RCM) is a form of cardiomyopathy Cardiomyopathy is a group of diseases that affect the heart muscle Cardiac muscle (also called heart muscle or myocardium) is one of three types of vertebrate Vertebrates () comp ...

Restrictive cardiomyopathy
(RCM) ** Acquired *** Stress cardiomyopathy ***
Myocarditis Myocarditis, also known as inflammatory cardiomyopathy, is inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogen In biology Biology is the na ...
,
inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogen In biology Biology is the natural science that studies life and living organisms, including their anato ...
of and injury to heart tissue due in part to its infiltration by
lymphocytes A lymphocyte is a type of white blood cell in the immune system of gnathostomata, jawed vertebrates. Lymphocytes include natural killer cells (which function in cell-mediated immunity, cell-mediated, cytotoxicity, cytotoxic innate immune system, i ...

lymphocytes
and
monocytes Monocytes are a type of ''leukocyte'', or white blood cell White blood cells (WBCs), also called leukocytes or leucocytes, are the cells of the immune system The immune system is a network of biological processes that protects an organi ...

monocytes
***
Eosinophilic myocarditis Eosinophilic myocarditis is inflammation in the heart muscle that is caused by the infiltration and destructive activity of a type of white blood cell, the eosinophil. Typically, the disorder is associated with hypereosinophilia, i.e. an eosino ...
,
inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogen In biology Biology is the natural science that studies life and living organisms, including their anato ...
of and injury to heart tissue due in part to its infiltration by
eosinophils Eosinophils, sometimes called eosinophiles or, less commonly, acidophils, are a variety of white blood cell White blood cells (WBCs), also called leukocytes or leucocytes, are the cells of the immune system The immune system is a network of ...
*** Ischemic cardiomyopathy (not formally included in the classification as a direct result of another cardiac problem) * Secondary/extrinsic cardiomyopathies ** Metabolic/storage *** Fabry's disease ***
Hemochromatosis Iron overload or haemochromatosis (also spelled ''hemochromatosis'' in American English American English (AmE, AE, AmEng, USEng, en-US), sometimes called United States English or U.S. English, is the set of variety (linguistics), varietie ...
** Endomyocardial *** Endomyocardial fibrosis ***
Hypereosinophilic syndrome Hypereosinophilic syndrome is a disease characterized by a persistently elevated eosinophil count (≥ 1500 eosinophils/mm³) in the blood for at least six months without any recognizable cause, with involvement of either the heart The h ...
** Endocrine ***
Diabetes mellitus Diabetes mellitus, commonly known as just diabetes, is a group of metabolic disorders characterized by a hyperglycemia, high blood sugar level over a prolonged period of time. Symptoms often include frequent urination, Polydipsia, increased th ...
***
Hyperthyroidism Hyperthyroidism is the condition that occurs due to excessive production of thyroid hormone File:Thyroid_system.svg, upright=1.5, The thyroid The thyroid, or thyroid gland, is an endocrine gland in vertebrates. In humans it is in the neck ...
***
Acromegaly Acromegaly is a disorder that results from excess growth hormone Growth hormone (GH) or somatotropin, also known as human growth hormone (hGH or HGH) in its human form, is a peptide hormonePeptide hormones or protein hormones are hormones ...

Acromegaly
** Cardiofacial ***
Noonan syndrome Noonan syndrome (NS) is a genetic disorder A genetic disorder is a health problem caused by one or more abnormalities in the genome In the fields of molecular biology Molecular biology is the branch of biology Biology ...
** Neuromuscular ***
Muscular dystrophy Muscular dystrophies (MD) are a genetically and clinically heterogeneous group of rare neuromuscular disease A neuromuscular junction (or myoneural junction) is a chemical synapse between a motor neuron A motor neuron (or motoneuron) is a n ...
***
Friedreich's ataxia Friedreich's ataxia (FRDA or FA) is an autosomal-recessive genetic disease that causes difficulty walking, a loss of sensation in the arms and legs, and impaired speech that worsens over time. Symptoms generally start between 5 and 20 years ...
** Other *** Obesity-associated cardiomyopathy


Treatment

Treatment may include suggestion of lifestyle changes to better manage the condition. Treatment depends on the type of cardiomyopathy and condition of disease, but may include medication (conservative treatment) or iatrogenic/implanted
pacemakers A cardiac pacemaker (or artificial pacemaker, so as not to be confused with the cardiac pacemaker, natural pacemaker of the heart), is a medical device that generates electrical impulses delivered by electrodes to cause the heart muscle chambers ...
for slow heart rates,
defibrillators Defibrillation is a treatment for life-threatening cardiac dysrhythmia Arrhythmia, also known as cardiac arrhythmia or heart arrhythmia, is a group of conditions in which the heartbeat is irregular, too fast, or too slow. The heart rate tha ...

defibrillators
for those prone to fatal heart rhythms,
ventricular assist device A ventricular assist device (VAD) is an electromechanics, electromechanical device for assisting cardiac circulation, which is used either to partially or to completely replace the function of a failing heart. The function of VADs is different fro ...

ventricular assist device
s (VADs) for severe heart failure, or
ablation Ablation is removal or destruction of material from an object by vaporization, chipping, or other erosion, erosive processes. Examples of ablative materials are described below, and include spacecraft material for ascent and atmospheric reentry, ...
for recurring dysrhythmias that cannot be eliminated by medication or mechanical cardioversion. The goal of treatment is often symptom relief, and some patients may eventually require a
heart transplant A heart transplant, or a cardiac transplant, is a surgical transplant procedure performed on patients with end-stage heart failure Heart failure (HF), also known as congestive heart failure (CHF), (congestive) cardiac failure (CCF), and decomp ...

heart transplant
.


See also

*
Myopathy In medicine Medicine is the science Science () is a systematic enterprise that builds and organizes knowledge Knowledge is a familiarity, awareness, or understanding of someone or something, such as facts ( descriptive knowledge), ...
, a condition affecting
skeletal muscles Skeletal muscles (commonly referred to as muscles) are Organ (biology), organs of the vertebrate muscular system that are mostly attached by tendons to bones of the skeleton. The muscle cells of skeletal muscles are much longer than in the other ...

skeletal muscles
* Fibrosing cardiomyopathy, a disease in great apes


References


Further reading

* * * * *


External links

* {{Authority control Wikipedia medicine articles ready to translate RTTEM