Cardiomyopathy, the Disease of the Heart Muscle Itself
Cardiomyopathy is disease of the heart muscle rather than the arteries. The main types, why it can run in families, and the form that appears after childbirth.
Last reviewed: by Dr. Muhammad Ali Khan, FCPS Cardiology
Key takeaways
- Cardiomyopathy means the heart muscle itself is diseased. That is different from coronary artery disease, where the muscle is normal but its blood supply is blocked.
- The muscle can stretch and become weak and baggy (dilated), thicken abnormally (hypertrophic), or stiffen so it cannot fill properly (restrictive).
- Several forms run in families, so a diagnosis in one person is a reason to check close relatives. This matters more where marriage within the family is common.
- Heart failure appearing in the last month of pregnancy or in the months after delivery is a recognised condition called peripartum cardiomyopathy, and it is under-recognised in Pakistan.
- Fainting during exercise, or a family history of sudden death in someone young, needs assessment rather than reassurance. Call 1122 for a collapse.
Cardiomyopathy means the heart muscle itself is diseased. That is a different problem from the one most people picture when they think about heart disease, where the muscle is healthy but a blocked artery is starving it. Here the muscle is the problem, and the arteries may be perfectly clear.
Dr. Muhammad Ali Khan, Consultant Cardiologist in Abbottabad, sees this most often in two situations: a younger patient whose heart is weak with no blocked arteries to explain it, and a woman who has become breathless in the months around childbirth.
What are the main types?
Three patterns, described by what the muscle has done.
| Type | What the muscle does | What it causes |
|---|---|---|
| Dilated | Stretches, thins and becomes baggy | Weak pumping, so heart failure symptoms: breathlessness, swelling, fatigue |
| Hypertrophic | Thickens abnormally, sometimes obstructing outflow | Chest pain, fainting on exertion, and rhythm problems that can be dangerous |
| Restrictive | Stiffens so the chambers cannot fill properly | Breathlessness and swelling despite reasonable pumping strength |
A fourth situation sits slightly apart. Peripartum cardiomyopathy is heart failure that appears in the last month of pregnancy or in the months after delivery, in a woman with no previous heart problem. It is not rare and it is missed constantly, because the symptoms overlap almost exactly with how a woman is expected to feel at the end of a pregnancy.
What does it feel like?
The symptoms are the symptoms of a heart that is not keeping up, which is why cardiomyopathy is so often mistaken for something else first.
- Breathlessness on effort, and later while lying flat
- Waking at night needing to sit up to breathe
- Swelling of ankles, feet or abdomen
- Tiredness that does not match what you have done
- Palpitations, or an irregular pulse
- Dizziness or fainting, particularly during exertion rather than after it
- In a fit person, simply not being able to do what you could last year
The one to take most seriously is fainting during exercise. Fainting after exercise, in heat, or after standing a long time is usually something more benign. Fainting in the middle of exertion is different, and in a young person it should lead to an ECG and an echocardiogram rather than to reassurance.
What causes it?
Sometimes a clear cause, often not.
Inherited forms are common, and hypertrophic cardiomyopathy in particular runs in families often enough that a diagnosis in one person is a reason to assess the immediate relatives. This has extra weight in Hazara, where marriage within the extended family is usual, because a condition carried in the family can surface in more branches than anyone expects. The same reasoning appears on our page about congenital heart disease.
Other recognised causes include a viral illness that inflamed the heart muscle, years of poorly controlled high blood pressure, heavy alcohol use, some chemotherapy medicines, and a heart rhythm that has run too fast for too long. Thyroid disease and severe anaemia can produce a similar picture and are worth excluding, because both are treatable.
In a substantial proportion of cases no cause is ever identified, and treatment proceeds on what the heart is doing rather than on why.
When should you go to the Emergency?
Go straight to hospital, do not wait for an appointment, if there is:
- Collapse or fainting, particularly during exercise
- Severe breathlessness, or breathlessness that stops you lying flat
- Chest pain with sweating or breathlessness
- A racing, irregular pulse that will not settle, especially with dizziness
Call 1122 or go to DHQ Hospital Abbottabad Emergency, which runs around the clock.
For a woman in the weeks after delivery, breathlessness that is worsening rather than settling, or an inability to lie flat, deserves urgent assessment. It is too often put down to weakness after childbirth.
How is it diagnosed?
An echocardiogram is the central test. It measures the pumping strength, shows the thickness of the muscle wall, and reveals how the chambers are filling. In most cases it is what makes the diagnosis.
An ECG comes first and frequently gives the initial clue, particularly in hypertrophic cardiomyopathy where the tracing is often abnormal well before symptoms appear. Holter monitoring looks for dangerous rhythms that come and go. Blood tests check thyroid function, kidney function and anaemia.
Two further steps are common. An angiography or CT angiography may be needed to prove the arteries are clear, because a weak heart from blocked arteries is treated differently. And cardiac MRI, where available, often distinguishes one type of cardiomyopathy from another when the echo leaves the question open. TODO: confirm nearest centre and referral pathway for cardiac MRI
How is it treated?
Better than it used to be, and this is worth saying plainly to anyone who has just been given the diagnosis.
The medicines used for heart failure form the backbone: drugs that take load off the heart, beta-blockers that slow and protect it, and newer classes that have changed outcomes substantially over the last decade. The European Society of Cardiology publishes detailed guidance on cardiomyopathy management, and the direction of travel in it has been consistently towards better survival.
Where the risk of a dangerous rhythm is high, an implantable defibrillator may be recommended. That decision is made with a specialist centre rather than in a clinic. TODO: confirm referral pathway for implantable defibrillators
Where there is a treatable cause, treating it can transform the picture. Stopping alcohol, controlling a persistently fast rhythm, or managing peripartum cardiomyopathy early can each bring pumping strength back a long way.
Living with it
Most of the day-to-day work is the same as for heart failure: take the medicines without gaps, watch salt, weigh yourself regularly and report a rapid gain, and keep appointments even when you feel well. Our guide to tracking weight and fluid covers the practical routine.
Two things are specific to cardiomyopathy. First, exercise advice is individual rather than general, especially in hypertrophic cardiomyopathy where competitive and high-intensity sport may need restricting. Ask rather than assume. Second, if your form is inherited, the conversation includes your family, and arranging screening for parents, siblings and children is part of the treatment rather than an optional extra.
Appointments with Dr. Muhammad Ali Khan are available at both Abbottabad clinics Monday to Saturday for Rs. 2,000, follow-ups at Rs. 1,000, or by online video consultation at Rs. 2,500. Bring every echo report you have, because the trend in pumping strength over time matters more than any single number.
Where can I have this checked done in Abbottabad?
Dr. Muhammad Ali Khan, Consultant Cardiologist, consults at three clinics in Abbottabad, six days a week. Two sit beside DHQ Hospital in the city centre, and one is near Ayub Medical Complex on the Mandian side. Patients travel in from Haripur, Havelian and Mansehra as well.
- ADC AbbottabadEman Plaza, near Shafiq Medical Centre, MandianMon–Sat, 2:00 PM – 6:00 PM
- IDC AbbottabadSmall Industry Road, near Ayub Medical Complex (Mandian side)Mon–Sat, 6:00 PM – 9:00 PM
Outside Abbottabad? An online video consultation works for report reviews and follow-ups from anywhere in Pakistan.
Frequently asked questions
What is the difference between cardiomyopathy and heart failure?
Cardiomyopathy is a disease of the heart muscle. Heart failure is what happens when any heart, for any reason, cannot pump well enough to meet the body's needs. So cardiomyopathy is one possible cause and heart failure is the consequence. Someone can have cardiomyopathy for years before the heart starts failing, and plenty of heart failure has nothing to do with cardiomyopathy at all, most commonly following a heart attack.
Dil ka pattha kamzor hone ka matlab kya hai?
When people say the heart muscle has become weak, they usually mean the pumping strength measured on an echo has fallen below normal. The medical term for that measurement is ejection fraction. A weak muscle can come from a blocked artery that has damaged part of it, from years of untreated high blood pressure, from a virus, or from a cardiomyopathy where the muscle itself is the problem. The treatment differs depending on which of those it is, which is why the cause gets investigated rather than assumed.
Can cardiomyopathy run in families, and should relatives be checked?
Yes, several forms are inherited, and hypertrophic cardiomyopathy in particular is passed down frequently enough that a new diagnosis is a reason to assess close relatives. Parents, brothers, sisters and children are the ones who matter most. This carries extra weight where marriage within the extended family is common, because an inherited condition can appear in more branches of the family than expected. Screening usually starts with an ECG and an echocardiogram.
Can a woman develop heart failure during or after pregnancy?
Yes. Peripartum cardiomyopathy is heart failure appearing in the final month of pregnancy or within several months after delivery, in a woman with no previous heart disease. It is easily missed because breathlessness, tiredness and swollen ankles are all common in late pregnancy anyway. What should prompt assessment is breathlessness that is getting worse rather than better after delivery, being unable to lie flat, or waking at night short of breath. Many women recover well when it is caught, which is the argument for taking it seriously early.
Why do young, apparently fit people sometimes collapse during sport?
The commonest identified cause worldwide is hypertrophic cardiomyopathy, where the heart muscle is abnormally thickened. It often causes no symptoms at all until it causes a serious one, which is what makes it frightening. Warning signs worth acting on are fainting during exercise rather than after it, chest pain on exertion in a young person, and a family history of unexplained sudden death under fifty. Any of those deserves an ECG and an echo rather than reassurance.
Can cardiomyopathy be cured or reversed?
Some forms can improve a great deal and a few can largely reverse, particularly where there is a treatable cause such as heavy alcohol use, a persistently fast heart rhythm, or peripartum cardiomyopathy that responds to treatment. Inherited forms are not cured, but they are managed, and modern heart failure medicines have changed what that management achieves. The realistic aim in most cases is a heart that works well enough for an ordinary life, with regular review.
Book a consultation with Dr. Muhammad Ali Khan
Consultant Cardiologist (FCPS Cardiology). Two clinic locations in Abbottabad plus online video consultation across Pakistan. Clinic fee Rs. 2,000, online Rs. 2,500. By appointment only.