How Is Cardiomyopathy Treated?
Not everyone with cardiomyopathy needs treatment.
People who have no symptoms may not need treatment. In some cases, dilated
cardiomyopathy that comes on suddenly may even go away on its own. For other
people with cardiomyopathy, treatment is necessary.
Specific treatments depend on the type of
cardiomyopathy, how severe the symptoms and complications are, and the age and
overall health of the person.
Goals of Treatment
The main goals of treating cardiomyopathy are
to:
- Manage any conditions that cause or contribute to
the cardiomyopathy
- Control symptoms so that the person can live as
normally as possible
- Stop the disease from getting worse
- Reduce complications and the chance of sudden
cardiac death
Specific Types of Treatment
Treatments for cardiomyopathy may include medicines,
surgery, nonsurgical procedures, and lifestyle changes.
Medicines
A number of medicines may be used to treat
cardiomyopathy, including:
- Diuretics, which remove excess fluid and sodium
from the body.
- Angiotensin-converting enzyme (ACE) inhibitors,
which lower
blood
pressure and reduce stress on the heart.
- Beta-blockers, which slow the heart rate by
reducing the speed of the heart's contractions. These medicines also lower
blood pressure.
- Calcium channel blockers, which slow a rapid
heartbeat by reducing the force and rate of heart contractions. These medicines
also lower blood pressure.
- Digoxin, which increases the force of heart
contractions and slows the heartbeat.
- Anticoagulants, which prevent blood clots from
forming. Anticoagulants are often used in the treatment of dilated
cardiomyopathy.
- Antiarrhythmia medicines, which keep the heart
beating in a normal rhythm.
- Antibiotics, which are used before dental or
surgical procedures. Antibiotics help to prevent
endocarditis, an infection of the heart walls, valves, and
vessels.
- Corticosteroids, which reduce inflammation.
Surgery
Doctors can use several different types of surgery
to treat cardiomyopathy, including removing part of the enlarged heart muscle
(septal myectomy) and implanting devices that help the heart beat more
effectively. Heart transplant is sometimes used in cases of severe heart
failure.
Septal myectomy. Septal myectomy (also called
septal myomectomy) is open-heart surgery for people with hypertrophic
obstructive cardiomyopathy and severe symptoms. It is generally used in younger
patients and when medicines aren't working well.
In septal myectomy, a surgeon removes part of the
thickened septum that is bulging into the left ventricle. This widens the
pathway in the ventricle that leads to the aortic valve and improves blood flow
through the heart and out to the body. The tissue that is removed does not grow
back. If necessary, the mitral valve can be repaired or replaced at the same
time. This surgery is often successful, and the person can return to a normal
life with no symptoms.
Surgically implanted devices. Surgeons can
place several different types of devices in the heart to help it beat more
effectively. One device is a pacemaker, which electronically helps maintain
normal heart rhythm. Sometimes, doctors choose to use a biventricular
pacemaker, which coordinates contractions between the heart's left and right
ventricles.
A left ventricular assist device (LVAD) helps the
heart pump blood to the body. LVAD can be used as a long-term therapy or as a
short-term treatment for people who are waiting for a heart transplant.
An implantable cardioverter defibrillator (ICD) is
used in people who are at risk of life-threatening
arrhythmia or sudden cardiac death. This small device is
implanted in the chest and connected to the heart with wires. If the ICD senses
a dangerous change in heart rhythm, it will send an electric shock to the heart
to restore a normal heartbeat.
Heart transplant. In this surgery, a doctor
replaces a person's diseased heart with a healthy heart from a person who has
recently died. It is a last resort for people with heart failure when all other
treatments have failed.
Nonsurgical Procedure
Alcohol septal ablation. In this procedure, a
doctor injects ethanol (a type of alcohol) through a catheter into the small
artery that supplies blood to the thickened area of heart muscle. The alcohol
kills the cells and the thickened tissue shrinks to a more normal size. Blood
can flow freely through the pathway in the ventricle that leads to the aortic
valve, and symptoms improve.
Lifestyle Changes
The doctor may recommend lifestyle changes to manage
a condition that is causing the cardiomyopathy. These changes may help reduce
symptoms. Lifestyle changes may include:
- Quitting smoking
- Losing excess weight
- Eating a low-salt diet
- Getting moderate exercise, such as walking, and
avoiding strenuous exercise
- Avoiding the use of alcohol and illegal
drugs
- Getting enough sleep and rest
- Reducing stress
- Treating underlying conditions, such as diabetes
and high
blood pressure
|