Weak Heart: Cardiomyopathy
Cardiomyopathy refers to a weakening of the heart muscle. This is a serious and potentially dangerous condition that may result in:
Evaluation: Searching for Reversible Causes.
One of the most common causes of a cardiomyopathy is coronary artery disease/CAD. The medical term is ischemic cardiomyopathy. As outlined below, the approach will be to confirm the severity of coronary artery blockages and perform a bypass surgery.
CAD: Severe CAD may limit the function of the heart (left ventricle). Think of your heart as a V8 engine. However, there are blockages in the ‘fuel line’ which limits horsepower. So rather than the horsepower of a V8 engine, the heart may be performing like a 3-cylinder engine.
A viral illness, excessive alcohol, hypertension, a fast heartbeat (arrhythmia/tachycardia), cancer therapy (chemotherapy/radiation therapy), inherited, etc.
Diagnostic Evaluation will include:
History and Physical
L/R cardiac catheterization
Cardiac MRI (CMR)
Treatment: Prevention of Sudden Cardiac Death (SCD)
The treatment goal of cardiomyopathy is to increase strength of the heart. If not, then a defibrillator may be required to prevent sudden death. SCD or sudden death results from a damaged heart muscle that suddenly ‘races’ out of control: ventricular fibrillation.
If no CAD is present, then maximal medical management (MMT) will follow per ACC/AHA guidelines.
A number of types of cardiac medications will be utilized intended to lower blood pressure, remove excess body fluid, ‘remodel’ the left ventricle (heart muscle).
If severe coronary artery disease is present, performing a bypass surgery may free coronary obstructions and strengthen the heart.
Ablation of arrhythmias such as frequent PVC or AFIB may improve cardiac function.
If the heart remains weakened, LVEF < 35%, then a defibrillator will be required to present sudden cardiac death.
Cardiac transplantation is the ultimate treatment for cardiomyopathy, unfortunately.
Off Island Evaluations:
I recommend a 'best here' 'best there' approach to cardiovascular care. After consulting with the 'best' cardiologist locally, consider obtaining a second opinion with experts at leading institutions. Medicare and most PPO insurance will cover such evaluations. However, certain Hawaii-based insurance carriers discourage off-Island evaluations, which I do not agree with. Cardiomyopathy may have implications to family members and screening studies for first-degree relatives is typically recommended.
Note: Understanding your heart condition is not difficult. Patients become frustrated and confused when doctors don’t explain things clearly. If you don’t understand what your doctor is talking about, then you won’t be able to ask meaningful questions. I hope that my posts provide you with a framework that you can build upon to become an active participant in your healthcare.
Gregg Yamada MD FACC
Disclaimer: The information provided is educational and should not be taken as medical advice. I am a doctor, but I am not your doctor. Please schedule an appointment with your doctor to discuss these issues and to determine what is right for you.
© 2019. Gregg M. Yamada, MD FACC. All rights reserved.