Often Short of Breath, Dizzy, and Easily Tired? Watch Out for Cardiomyopathy: Know the Symptoms and Treatment

People with cardiomyopathy are at risk of sudden death if a life-threatening arrhythmia occurs, such as ventricular fibrillation. Sudden death can happen without warning and is often associated with intense physical activity or emotional stress.

The heart is a vital organ that works nonstop to pump blood throughout the body. However, the heart can sometimes develop problems, one of which is cardiomyopathy, a condition in which the heart muscle becomes weak or thick, interfering with its ability to pump blood effectively. In this article, we will discuss cardiomyopathy in more detail, including its types, causes, symptoms, and treatment.

01 / Heart Disease

What Is Cardiomyopathy?

Cardiomyopathy is a medical condition in which the heart muscle undergoes changes that interfere with its ability to pump blood throughout the body. These changes can take the form of thickening, stretching, or stiffening of the heart muscle. As a result, the heart cannot work as efficiently as it should, which can lead to symptoms such as fatigue, shortness of breath, and even heart failure.

Cardiomyopathy can appear without a clear cause, or it can be triggered by genetic factors, high blood pressure, previous heart disease, or certain infections.

02 / Heart Disease

Types of Cardiomyopathy

Understanding the different types of cardiomyopathy can help us respond better to symptoms and appropriate treatment. Here are the five main types of cardiomyopathy you should know about:

1. Dilated Cardiomyopathy (DCM): Dilated cardiomyopathy is a condition in which the heart chambers, especially the left ventricle, become enlarged and weakened. As a result, the heart cannot pump blood throughout the body effectively. The cause is often unknown, but it may be related to genetic factors, infections, or excessive alcohol consumption. This condition is one of the most common types of cardiomyopathy and can lead to heart failure if not treated properly.
2. Hypertrophic Cardiomyopathy (HCM): Hypertrophic cardiomyopathy occurs when the heart muscle thickens for no clear reason, which can obstruct blood flow out of the heart. This condition often has a genetic basis and can be found in younger family members. Symptoms include shortness of breath and dizziness, especially during exercise. Some people may not experience significant symptoms and are still able to live a normal life.
3. Restrictive Cardiomyopathy (RCM): Restrictive cardiomyopathy makes the heart muscle stiff, reducing its ability to relax and fill with blood between heartbeats. This type is rare and can be caused by other diseases that affect the heart, such as amyloidosis. People with restrictive cardiomyopathy may experience fatigue and shortness of breath and need treatment focused on improving heart function.
4. Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): This type of cardiomyopathy is a genetic disorder in which the muscle tissue of the right ventricle is replaced by fatty or fibrous tissue, which can disrupt the heart’s electrical system and cause arrhythmias. Its main symptoms include an irregular heartbeat, dizziness, and sudden loss of consciousness. This condition is often found in young athletes and requires a careful management approach.
5. Takotsubo Cardiomyopathy (Takotsubo Syndrome): Also known as “broken heart syndrome,” this cardiomyopathy is usually triggered by extreme emotional or physical stress. The condition causes temporary weakening of the heart muscle, mainly the left ventricle, giving it a shape that resembles a traditional Japanese octopus trap, the “tako-tsubo.” Although it can look like a heart attack, on average this condition can recover fully within a few weeks with appropriate treatment.

Epidemiology of Cardiomyopathy

Based on the latest data from the Indonesian Ministry of Health (Kemenkes) in 2022, the prevalence of cardiomyopathy in Indonesia is estimated at about 0.6% of the total population. This means that about 1.6 million Indonesians are living with this disease.

Meanwhile, at the global level, according to the latest data from the American Heart Association (AHA) in 2023, the worldwide prevalence of cardiomyopathy is estimated at about 1 in 500 people, or the equivalent of 0.2% of the global population.

03 / Heart Disease

Symptoms and Signs of Cardiomyopathy

Common Symptoms

Cardiomyopathy is a condition that can affect the heart’s ability to pump blood, and its symptoms can vary depending on the type and severity of the disease. However, there are several common symptoms that people with cardiomyopathy often experience. Frequent symptoms include:

• Shortness of breath, which occurs because fluid builds up in the lungs when the heart is unable to pump blood effectively.
• Prolonged fatigue, even after light activity, because the muscles and organs do not get enough oxygen.
• Swelling, which usually occurs in the legs, ankles, or abdomen and is caused by fluid buildup in the body.
• An irregular heartbeat, or palpitations, is also often reported and may be accompanied by dizziness or fainting, especially if blood flow to the brain is disrupted.
• Chest pain can occur in some cases, although it is less common than the other symptoms.

It is important to note that these symptoms are not always immediately linked to cardiomyopathy, because they can resemble other heart conditions. That is why an accurate medical diagnosis is essential to make sure the right treatment is given.

If you experience these symptoms, you are advised to consult a healthcare professional promptly. By understanding the early symptoms, we can take preventive action sooner to protect heart health.

Symptoms by Type of Cardiomyopathy

Each type of cardiomyopathy has characteristic symptoms that can help identify the condition more precisely. Here is an explanation of the symptoms of each type of cardiomyopathy:

1. Dilated Cardiomyopathy (DCM):
   • Shortness of Breath: This can occur during light physical activity or at rest because the enlarged heart cannot pump blood efficiently.
   • Fatigue: People with this condition often feel tired because of reduced blood flow throughout the body.
   • Swelling: There may be swelling in the legs, ankles, or abdomen due to fluid buildup.
   • Irregular Heartbeat: Patients may experience arrhythmia or a pounding, racing heartbeat.
2. Hypertrophic Cardiomyopathy (HCM):
   • Chest Pain: Occurs mainly during exercise or strenuous activity.
   • Shortness of Breath: The thickened heart muscle can block the normal flow of blood out of the heart.
   • Dizziness or Fainting: This can happen, especially after physical activity, because of disrupted blood flow.
   • Irregular Heartbeat: Arrhythmias or palpitations are common.
3. Restrictive Cardiomyopathy (RCM):
   • Shortness of Breath: Occurs more often and can get worse over time.
   • Fatigue: A prolonged feeling of tiredness because the heart cannot relax and fill with blood optimally.
   • Swelling: Occurs in the abdomen and limbs due to fluid buildup.
4. Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC):
   • Irregular Heartbeat: Patients often experience arrhythmias that can be fatal if left untreated.
   • Dizziness or Fainting: Usually caused by heart rhythm disturbances.
   • Fatigue: Tiredness that may be felt because the heart is not pumping blood optimally.
5. Takotsubo Cardiomyopathy (Takotsubo Syndrome):
   • Chest Pain: Often sudden and can resemble a heart attack.
   • Shortness of Breath: Appears suddenly along with extreme physical or emotional stress.
   • Irregular Heartbeat: An abnormal heartbeat shortly after severe stress.

The signs above indicate that you need to consult a medical professional promptly. Early detection and management of cardiomyopathy are key to preventing complications such as heart failure and improving the patient’s prognosis.

If you or someone close to you experiences these symptoms, contact a healthcare provider promptly to get a diagnosis and appropriate treatment.

04 / Heart Disease

Causes and Risk Factors

Genetic Causes

Cardiomyopathy is often linked to genetic factors, meaning the condition can be inherited within families. Research shows that certain gene mutations can affect the structure and function of the heart muscle, increasing the risk of various types of cardiomyopathy *. This means that if a family member is diagnosed with cardiomyopathy, other family members may also have a higher risk of developing a similar condition. (* Source: ScienceDirect®, Genetic Markers of Cardiovascular Disease)

In some cases, cardiomyopathy results from mutations that can be passed down from generation to generation. For example, hypertrophic cardiomyopathy is one of the forms most often associated with genetic causes. These mutations can affect important proteins in the heart muscle, causing the thickening of the heart wall that is characteristic of this condition.

Up to 50% of dilated cardiomyopathy cases also have a genetic link *. The mutations involved here can affect the heart’s ability to pump blood effectively, which can eventually lead to an enlarged heart. (* Source: National Library of Medicine, Genetics of Dilated Cardiomyopathy)

Identifying a family history of this condition is an important step in managing risk and allows individuals to get checked early.

Genetic counseling may be recommended if you have a family history of cardiomyopathy, to understand your risk and take any preventive steps that may be needed.

Non-Genetic Causes

Besides genetic factors, cardiomyopathy can also develop from a number of non-genetic causes. These include infections, exposure to toxins, and other medical conditions that can directly affect the heart muscle.

• Infections: Some viral infections, such as those caused by the Coxsackie B virus, can damage the heart muscle, a condition known as myocarditis. Myocarditis can progress to cardiomyopathy if not treated properly. Bacterial, parasitic, or fungal infections can also cause heart inflammation that carries the same risk.
• Toxin Exposure: Excessive alcohol consumption and illegal drug use, such as cocaine, are known to damage the heart muscle, which can worsen cardiomyopathy. In addition, some toxic chemicals and certain substances used in cancer therapy, such as anthracycline chemotherapy drugs, can also have long-term effects on heart health.
• Other Diseases: Chronic health conditions such as hypertension (high blood pressure), diabetes, and thyroid disease can increase the risk of developing cardiomyopathy. Hypertension, for example, can make the heart work harder than usual, which over time can lead to thickening and weakening of the heart muscle.

Risk Factors That Worsen the Condition

Several risk factors can worsen cardiomyopathy and increase the likelihood of complications. Knowing these factors is important so that prevention and management efforts can be made to protect heart health.

• High Blood Pressure (Hypertension): Hypertension can make the heart work harder to pump blood. Over time, this constant pressure can weaken or thicken the heart muscle, worsening the symptoms of cardiomyopathy.
• Unhealthy Lifestyle: Habits such as smoking, excessive alcohol consumption, and a diet high in saturated fat or salt can worsen heart conditions. These lifestyle choices can increase the risk of heart disease and contribute to the development of cardiomyopathy.
• Obesity: Excess body weight puts an extra burden on the heart as it pumps blood throughout the body. Obesity is often associated with high blood pressure, diabetes, and high cholesterol, all of which are risk factors for cardiomyopathy.
• Diabetes: People with diabetes have a higher risk of developing heart disease and cardiomyopathy. High blood sugar levels can damage the blood vessels and nerves that control the heart.
• History of Heart Disease: A previous heart attack or coronary heart disease can cause direct damage to the heart muscle, increasing susceptibility to cardiomyopathy.
• Nutritional Deficiencies: Inadequate nutrition, especially a lack of important vitamins and minerals such as vitamin B1 (thiamine) and selenium, can affect heart function.

05 / Heart Disease

Diagnosing Cardiomyopathy

Diagnosing cardiomyopathy requires a thorough approach to make sure the condition is identified accurately. Here are the general steps usually taken in the diagnostic process:

1. Medical History: Taking a complete medical history is the first step in diagnosing cardiomyopathy. The doctor will ask about the patient’s symptoms, family health history, and possible risk factors. It is important to give accurate information about any history of heart disease in the family, alcohol use, and other lifestyle habits that may affect heart health.
2. Physical Examination: During the physical examination, the doctor will listen to the heart and lungs with a stethoscope for abnormal sounds that may indicate a heart problem. The doctor may also check for swelling in the legs or abdomen that may indicate fluid buildup because the heart is not pumping blood well.
3. Diagnostic Tests and Procedures:
   • Electrocardiogram (ECG): This test is used to record the heart’s electrical activity. An ECG can help detect irregularities in the heart rhythm or damage to certain parts of the heart muscle.
   • Echocardiogram: An echocardiogram uses sound waves to create images of the heart that help the doctor see its structure and function. It is an important tool for determining how well the heart pumps blood and for seeing any thickening or enlargement of the heart walls.
   • Cardiac MRI: Cardiac Magnetic Resonance Imaging (MRI) provides a more detailed picture of the heart. This test is very useful for identifying changes in the heart muscle that cannot be seen on an echocardiogram.
   • Chest X-ray: This test can provide a general picture of the chest, including the heart and lungs. It is used to see whether the heart is enlarged or whether there is fluid around the lungs.
   • Genetic Testing: If there is a strong family history of cardiomyopathy, genetic testing may be done to identify gene mutations that may be responsible for the condition. This is important for determining the risk to other family members and for managing the disease.
   • Laboratory Tests: Blood tests can be used to check electrolyte levels, kidney function, and specific biomarkers that may indicate stress on the heart or damage to the heart muscle.

06 / Heart Disease

Treating Cardiomyopathy

Cardiomyopathy treatment aims to manage symptoms, improve quality of life, and prevent further complications. There are several approaches to treating cardiomyopathy, including medical and non-medical ones:

Medical and Non-Medical Approaches:

1. Medical: This involves using medications that aim to reduce the heart’s workload, improve its function, and lower the risk of complications.
2. Non-Medical: This includes lifestyle changes and managing existing risk factors, such as quitting smoking, managing body weight, and eating a healthy diet.

Commonly Used Medications:

• Beta-blockers: These medications work by lowering the heart rate and blood pressure, reducing the heart’s workload. Beta-blockers may help regulate an irregular heartbeat.
• ACE Inhibitors or ARNI (Angiotensin Receptor-Neprilysin Inhibitor): Help widen blood vessels, lower blood pressure, and reduce the heart’s workload. ARNI is a newer option used to replace ACE inhibitors in some patients with heart failure.
• Diuretics: Also known as “water pills,” diuretics help the kidneys remove excess fluid and salt from the body, which can reduce swelling and ease the burden on the heart.
• Mineralocorticoids: A class of steroid hormones that regulate the balance of salt and water in the heart chambers.
• SGLT2 Inhibitors: Used to prevent and slow the development of cardiorenal disease, which is a kidney disorder caused by heart disease.

Surgical and Interventional Procedures:

• Implantation of a Pacemaker or ICD: A pacemaker helps control an irregular heart rhythm, while an Implantable Cardioverter-Defibrillator (ICD) can stop a life-threatening arrhythmia by delivering an electric shock to the heart.
• Septal Myectomy: This is a surgical procedure to remove part of the thickened heart muscle in patients with hypertrophic cardiomyopathy, helping improve blood flow out of the heart.
• Heart Transplant: In very severe cases where other treatments are not effective, a heart transplant may be needed. This involves replacing the damaged heart with a healthy heart from a donor.

Lifestyle Changes:

Lifestyle changes play an important role in managing cardiomyopathy. These include:

• Healthy Diet: Eating foods low in salt and saturated fat to help manage blood pressure and body weight.
• Regular Exercise: Light to moderate physical activity can improve heart health, but it is important to consult your doctor about the type and intensity of exercise that is safe for you.
• Avoiding Alcohol and Smoking: Avoiding excessive alcohol consumption and quitting smoking can reduce the risk of complications and worsening of cardiomyopathy.

07 / Heart Disease

Possible Complications

Cardiomyopathy can cause various serious complications that affect the heart and the body’s overall health. Here are some of the main complications that may occur:

1. Heart Failure: Heart failure is a condition in which the heart cannot pump enough blood to meet the body’s needs. Cardiomyopathy weakens the heart muscle, making it harder for the heart to work efficiently. Symptoms of heart failure can include shortness of breath, extreme fatigue, and swelling in the legs and abdomen.
2. Arrhythmia: Arrhythmia is a heart rhythm disorder that can occur in people with cardiomyopathy. It can take the form of a heartbeat that is too fast, too slow, or irregular. Arrhythmia can cause dizziness, fainting, or palpitations. In some cases, a poorly managed arrhythmia can increase the risk of stroke or heart attack.
3. Pulmonary Embolism and Thromboembolism: Cardiomyopathy can increase the risk of dangerous blood clots forming. These clots can travel through the bloodstream and cause a pulmonary embolism if they become lodged in the blood vessels of the lungs, or a thromboembolism if they move to other parts of the body. This condition can cause sudden chest pain, shortness of breath, or even become life-threatening if not treated quickly.
4. Risk of Sudden Death: People with cardiomyopathy are at risk of sudden death if a life-threatening arrhythmia occurs, such as ventricular fibrillation. Sudden death can happen without warning and is often associated with intense physical activity or emotional stress. To reduce this risk, a device such as an Implantable Cardioverter-Defibrillator (ICD) is recommended for some high-risk patients.

Early detection and appropriate treatment may help minimize the impact of these complications on quality of life and overall heart health.

08 / Heart Disease

Preventing and Managing Cardiomyopathy

Managing cardiomyopathy requires preventive steps and long-term strategies to support a good quality of life for those living with it. Here are some ways to prevent and manage cardiomyopathy:

Prevention Steps:

1. Healthy Lifestyle: Following a healthy eating pattern that is low in salt and saturated fat is strongly recommended. Including more fruits, vegetables, whole grains, and lean protein can support heart health.
2. Regular Exercise: Moderate physical activity, such as walking, swimming, or cycling, can improve the heart’s endurance. It is important to consult your doctor about the type and intensity of exercise that is safe for you.
3. Avoiding Alcohol and Smoking: Cutting down on alcohol and quitting smoking can greatly reduce the risk of cardiomyopathy complications. Both of these factors are known to worsen heart conditions.
4. Managing Stress: Chronic stress can have a negative impact on heart health. Relaxation techniques such as meditation and yoga can help reduce stress.

Long-Term Management and Daily Life With Cardiomyopathy:

1. Routine Medical Monitoring: Seeing your doctor regularly to monitor your heart condition and adjust treatment as needed is an important part of long-term management.
2. Medications: Taking prescribed medications consistently, such as ACE inhibitors or beta-blockers, is very important for controlling blood pressure and preventing complications.
3. Symptom Awareness: Understanding and paying attention to new or worsening symptoms, such as shortness of breath or swelling, can help you get treatment early.
4. Self-Education: Staying informed about this condition and following the latest developments in cardiomyopathy treatment can help patients and their families make better decisions about care.
5. Social Support: Getting support from family, friends, or support groups can provide emotional help and ease the anxiety that may come with living with this condition.

Combining these prevention and active management strategies may help people living with cardiomyopathy achieve stability and improve their quality of life. Adopting healthy habits and ongoing medical monitoring are key to managing this condition.

09 / Heart Disease

Recent Research and Developments

Advances in research and technology continue to change the way we understand, diagnose, and treat cardiomyopathy. Here are some significant recent developments in this field:

Innovations in Diagnostics and Treatment:

• Advanced Imaging: Newer imaging technology, such as more detailed Cardiac MRI, provides a clearer picture of the heart’s structure and function. This allows for a more accurate diagnosis and monitoring of how the disease progresses over time.
• New Biomarkers: The discovery of new biomarkers in the blood may help detect cardiomyopathy earlier and better predict the course of the disease. These biomarkers can also help assess how well a treatment is working.

Clinical Studies and New Findings:

• Genetic Studies: Current research in genetics is identifying specific genes associated with various types of cardiomyopathy *. These studies help not only with diagnosis but also with developing more targeted therapies. (* Source: Springer Link, The Genetic Factors Influencing Cardiomyopathies and Heart Failure across the Allele Frequency Spectrum)
• Recent Clinical Trials: Various clinical trials are underway to evaluate the effectiveness of new drugs and combination therapies in reducing symptoms and improving heart function *. Some studies show promise for the use of cell-based therapies and immunological approaches to manage cardiomyopathy **. (* Source: Nature, New clinical trial design in precision medicine: discovery, development and direction | ** Source: ScienceDirect®, The recent advances in cell delivery approaches, biochemical and engineering procedures of cell therapy applied to coronary heart disease)

New Technologies and Gene Therapy:

• Gene Therapy: One promising area is gene therapy, which aims to repair or replace defective genes in heart cells that have undergone mutation. Early trials show potential for strengthening the heart muscle and reducing symptoms in patients with a clear genetic component *. (* Source: ScienceDirect®, Gene therapy for heart failure and cardiomyopathies)
• Advanced Implantable Devices: The development of implantable devices, such as smart pacemakers and ICDs that can adapt to a patient’s physiological changes in real time, may help control arrhythmias better and reduce the risk of heart failure.

These innovations play an important role in paving the way for more effective and personalized treatment options in cardiomyopathy care. If you are interested in innovative therapies or clinical trials, discuss these options with your doctor to decide which choice suits your medical needs.