Cardiomyopathy: Causes, And Prognosis

Cardiomyopathy: Causes, Treatments, & Prognosis
General Biology BIOL1114R122S-2101 Benson, Gifty

“Above all else, guard your heart, for it is the wellspring of life” (Proverbs 4:23, NIV). Although this is a proverb from the Bible and most likely not meant in a literal biological term, it is still fitting for everyday life. The heart is an absolute necessary part of human existence. The human heart is really quite simple when compared to other organs in the body. It is essentially a pump made of muscle about the size of a fist and weighs between nine and eleven ounces in a healthy adult. With every beat a heart pumps vital oxygenated blood throughout the body. When there is a deterioration of the heart muscle and
it no longer efficiently does its job it is called a cardiomyopathy. Translated literally, cardiomyopathy means heart muscle disease. The British Heart Journal affirms this saying cardiomyopathy is “heart muscle disease of unknown cause” (Goodwin, 1982).
There are several types of cardiomyopathies but they all fall into one of four main categories; these categories are dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy, and arrhythmogenic right ventricular dysplasia, each with its own believed cause, symptoms, treatment, and prognosis. The most common form of this disease is dilated cardiomyopathy. Dilated cardiomyopathy is a condition in which the heart muscle becomes dilated by stretching out. “When this happens, the heart muscle becomes weak, thin, or floppy and is unable to pump blood efficiently around the body. This can lead to fluid building up in the lungs, ankles, abdomen and other organs of the body and a feeling of being breathless. This collection of symptoms is known as heart failure” (McKenna). The causes of this form of cardiomyopathy have a wide range. This form of cardiomyopathy can be linked to genetics. It may be passed from one generation to another with as high as a one in three rate of being passed from parent to child. There are genetic marker tests that can be performed to possibly find out
if the genes for the disease are carried but do not necessarily mean you will develop the disease or develop the disease to the same extent as a parent or sibling. Dilated cardiomyopathy is carried on the X chromosome. The Cardiomyopathy Association explains that a father will always pass the gene to all daughters (X chromosome) and never their sons (Y chromosome), but a mother has a 50:50 chance of passing the disease to all of her children (McKenna). There are other causes of dilated cardiomyopathies. These include viral infections such as the common cold, auto immune disorders, and in rare cases even exposure to toxins and pregnancy. Most of the symptoms of dilated cardiomyopathy are silent in the beginning and some patients never experience any negative effects from their disease. Those who do experience symptoms generally have heart palpitations, swelling caused by excess fluid in their extremities, shortness of breath and fatigue. These are relatively the same as “heart failure.” The prognosis is relatively good for patients with dilated cardiomyopathy when caught early. Although there is currently no cure, there are medications to help with symptoms, lifestyle changes can help, and surgical procedures such as pacemaker implantation to control palpations. In severe cases a heart transplant may be considered. Restrictive cardiomyopathy is the rarest form of the cardiomyopathies. Like the dilated form, restrictive cardiomyopathy can be genetic but is usually caused by disease in another part of the body. This form of cardiomyopathy causes the heart muscle to become stiff and keep the chambers from filling properly. The heart generally still has a proper rhythm and all other functions work fine. There is just no stretching action which results in a lack of oxygenated blood. The symptoms are very similar to the dilated version including fatigue, shortness of breath, palpitations, and edema (swelling). There are also sometimes bloating in the abdomen, stomach issues, and a condition called heart block which is a type of arrhythmia (Texas Heart Institute). The prognosis for restrictive cardiomyopathy is not as blameless as for dilated. The severely damaged heart muscle cannot be repaired surgically. There are only treatments for symptoms and most patients will require transplant. Another form of cardiomyopathy is called hypertrophic cardiomyopathy. This form of cardiomyopathy is almost exclusively inherited. It is seen most commonly in children although it can occur at any age (Medline Plus, 2012). Symptoms for this form of cardiomyopathy are usually chest pain, fainting, dizziness, light headedness, heart palpitations, and shortness of breath. These symptoms often do not occur until brought on by physical activity and sometimes are followed shortly by death due to the fact that the condition was never diagnosed or treated. Treatments for this form of cardiomyopathy include medications to control heart rhythms, blood thinners to control clots, a pacemaker to control heartbeat, and an automatic defibrillator for those at risk for deadly arrhythmias (Medline Plus, 2012). The prognosis for these patients can be great or can be deadly. Many patients die suddenly or their disease worsens very quickly while others lead very normal long lives. The fourth major form of cardiomyopathy is arrhythmogenic right ventricular dysplasia. The cause of this type of cardiomyopathy is genetics. It is sometimes an inherited gene and sometimes a genetic abnormality (John Hopkins Medicine). There is also some evidence that an infection in the heart muscle could play a role. “The clinical hallmark of the disease are ventricular arrhythmias, arising predominantly form the right ventricle. The pathological hallmark of the disease is fibrofatty replacement of right ventricular myocardium. Recent research efforts have revealed that ARVD/C is caused by mutations in genes which encode desmosomal proteins” (John Hopkins Medicine). The symptoms of this form of cardiomyopathy are much like the other with palpitations, arrhythmias, and fainting. This form of cardiomyopathy also sometimes causes heart failure and sudden cardiac arrest. The treatment for ARVD/C is medications to reduce arrhythmias, ablation to reduce fatty deposits, and implantation of defibrillator and pacemaker to control heartbeat and shock in event the heart stops. The prognosis for this form of cardiomyopathy is positive. With proper care and monitoring, a patient should lead a long, active life. Heart disease remains the number one cause of death in America.
There are many diseases included in that category but the subcategory of cardiomyopathies contributed almost 30,000 deaths to the total every year for the past four years. This disease doesn’t receive attention like heart attacks and blocked arteries but the majority of these individuals could be saved with early detection through screenings and diagnostic testing. Simple blood tests will show death of cardiac enzymes. EKGs, stress tests, and other procedures can help with a diagnosis. If a patient has a family member, especially a parent or sibling with a cardiomyopathy, genetic testing should be pursued so that early prevention treatment can save or prolong a life. In the majority of cases, early death is not inevitable if this disease is
challenged.

Works Cited
Medline Plus. (2012, June 4). Retrieved March 24, 2013, from National Institutes of Health: http://www.nlm.nih.gov/medlineplus/ency/article/000192.htm
Goodwin, J. F. (1982). The Frontiers of Cardiomyopathy. The British Heart Journal, 1-18.
John Hopkins Medicine. (n.d.). Retrieved March 24, 2012, from hopkinsmedicine.org: http://www.hopkinsmedicine.org/heart_vascular_institute/clinical_services/centers_excellence/arvd/symptoms_diagnosis/genetics.html
McKenna, P. W. (n.d.). The Cardiomyopathy Association. Retrieved March 24, 2013, from The Cardiomyopathy Association: http:www.cardiomyopathy.org
(NIV). Proverbs 4:23. In The Bible.
Texas Heart Institute. (n.d.). Retrieved 24 2012, March, from Texas Heart Institute Heart Information Center: http://www.texasheartinstitute.org/HIC/Topics/Cond/restrict.cfm