Cardiomyopathy

Cardiomyopathy is a general term for diseases of the heart muscle (the myocardium). In these conditions the muscle becomes enlarged, thickened, or stiff, which makes it harder for the heart to pump blood around the body effectively. Over time this can lead to heart failure or abnormal heart rhythms.

There are several types, and the condition can affect people of any age, including children and young adults. Some people have no symptoms and are diagnosed during tests for another reason or through family screening.

Dilated cardiomyopathy is where the heart's main pumping chamber enlarges and weakens. Hypertrophic cardiomyopathy is where the heart muscle becomes abnormally thick, often inherited. Restrictive cardiomyopathy is where the muscle becomes stiff and cannot fill properly. Arrhythmogenic cardiomyopathy mainly affects the heart's rhythm and is also often inherited.

Knowing the type is important because it affects symptoms, treatment, and whether family members should be checked.

Symptoms vary widely. Many people have breathlessness (with activity or when lying down), tiredness, swelling of the ankles, legs, or abdomen, palpitations, dizziness, or chest discomfort. Others have no symptoms at all, especially early on.

Because some types can cause dangerous heart rhythms, symptoms such as fainting, or a family history of unexplained sudden death, are taken seriously and should be assessed promptly.

In many cases cardiomyopathy is inherited, caused by changes in genes that affect the heart muscle. Other causes include damage after a viral infection of the heart, long-standing high blood pressure, heart valve problems, heavy alcohol use, and some other medical conditions. Sometimes no cause is found.

Because inherited types run in families, when one person is diagnosed, close relatives may be offered assessment to check whether they are affected.

The main test is an echocardiogram, an ultrasound scan that shows the size, thickness, and pumping action of the heart. An electrocardiogram (ECG) records the heart's rhythm, and a cardiac MRI can give detailed pictures of the heart muscle.

Blood tests, monitoring the heart rhythm over time, and, for inherited types, genetic testing may also be used. Family members of someone with an inherited cardiomyopathy may be offered screening with similar tests.

There is often no cure, but treatment can control symptoms, protect the heart, and reduce the risk of complications. Medicines help the heart pump more efficiently, control blood pressure and heart rhythm, remove excess fluid, and prevent clots. Managing lifestyle factors and avoiding heavy alcohol are important.

Some people benefit from implanted devices — such as a pacemaker, an implantable defibrillator (ICD) to protect against dangerous rhythms, or cardiac resynchronization therapy (CRT). Procedures to correct rhythm problems or, in hypertrophic cardiomyopathy, to reduce thickened muscle may be used. In a small number of people with the most severe disease, advanced treatments such as a heart transplant are considered at specialist transplant centers.

The outlook varies with the type and severity. Many people live full, active lives with treatment and monitoring, particularly when the condition is diagnosed early and managed well. Regular follow-up helps keep symptoms controlled and catch any changes.

Inherited cardiomyopathy cannot be prevented, which is why family screening matters, but looking after general heart health — controlling blood pressure, avoiding heavy alcohol, and staying active as advised — supports the heart. Your cardiology team tailors advice to your type of cardiomyopathy.