Stress Management

Cardiomyopathy

Symptoms of Cardiomyopathy

• Shortness of breath at rest
• Dyspnea on minimal exertion
• Paroxysmal nocturnal dyspnea
• Postprandial dyspnea
• Fatigue
• Syncope (Fainting)
• Tachypnea
• Cyanosis, pallor
• Cool vasoconstricted extremities
• Diaphoresis
• Jugular venous distention
• Bi-basilar inspiratory rales
• S3 cardiac gallop
• Liver and spleen enlargement
• Ascites, edema
• Chest pain

Diagnosis of Cardiomyopathy

Many people are misdiagnosed of cardiac myopathy without a complete evaluation. They are put on heart drugs, when the real problem is in the lungs. Some are prescribed drugs to strengthen the heart, while their problem is that of a stiff heart.

Shortness of breath does not necessarily mean heart is weak. It can also signal problems in lungs. To diagnose cardiomyopathy accurately, it is necessary to rule out a number of other conditions that can also have symptoms mimicking that of cardiomyopathy. Physical examination is not sufficient to pin point the source of the problem. Often sophisticated tests such as echocardiogram have to be resorted to.

The three major syndromes that must be distinguished are:

1. Weak heart
2. Stiff heart
3. Lung disease

1. Weak heart:

When the heart is weak, it will pump less blood than is required by the body (this is called forward failure), starving the body of vital nutrients. This will make us extremely tired and fatigued. So, these are symptoms of a weak heart.

However, the mere presence of severe weakness and fatigue is not sufficient to conclude of a heart disease. That is because these symptoms are also exhibited by the following conditions:

Anemia

A "sluggish" thyroid

A variety of chronic illnesses

Merely being "run-down" and "out of shape"

So, these have be ruled out before diagnosing cardiomyopathy.

Another problem with a weakened heart is that it has difficulty filling with blood in between beats. (This is called backward failure.) Pressure inside the blood vessels increases, forcing fluid to squeeze out of the circulation and into the tissue of the body ( called edema).

When this occurs in the lungs, the patient develops shortness of breath because the airways fill with water (called pulmonary edema or pulmonary congestion). A characteristic sound of air passing through this water, called crackles, can be heard with the stethoscope.

Another sign of the backward failure is the build-up of blood in the arms and legs resulting in edema in these locations. Patients with heart failure often have swollen legs because gravity causes fluid to accumulate in the lower parts of the body.

However, edema can also come from the following sources; so they need to be ruled out in diagnosing cardiomyopathy:

Varicose veins

Poor circulation

Hormonal changes

Heart failure

2. Stiff heart:

A stiff heart beats strongly, ejecting adequate amounts of blood forward. But it has difficulty filling the heart. (Think of a stiff balloon. It is tough to fill the balloon with blood. So, it fills very slowly. However, it has no effect on air escaping.) 

The slow filling can

A stiff heart can lead to elevation of blood pressure and the buildup of fluid in the lungs. This can cause the victim to experience shortness of breath.

3. Lung disease:

Those with lung disease may experience several symptoms similar to those experienced by people with either weak or stiff hearts. It is difficult to tell just from physical examination whether you are suffering from pulmonary complications or from heart problems. The only sure way is to undergo specialized tests.

Differential Diagnosis of Cardiomyopathy

Severe pulmonary disease

Primary pulmonary hypertension

Recurrent Pulmonary embolism

Hypothyroidism

Some advanced forms of malignancy

Other Tests

Electrocardiogram
Echocardiogram
Nuclear multiple gaited acquisition ventriculogram (MUGA)- Ejection fraction of 25% or below. 
Cardiac catheterization

In patients who are being evaluated as possible transplant candidates, the following additional tests are usually performed:

Computed tomographic (CT) scans of the chest and abdomen
24 hour creatine clearance
Pulmonary function studies (including blood gas determination)
Serologies for hepatitis A, B. C, HIV, toxoplasma, cylomegalic inclusion virus and EB virus
Full panels of renal and liver function
A complete blood count with differential
A panorex dental x-ray

Prognosis

50% of the patients in New York functional class IV are expected to be dead within one year. In functional class III, it is probably 25%. With transplant, the outlook is brighter. 

Caution: Cardiomyopathy is a life-threatening condition. If you suspect you or someone you know is suffering from cardiomyopathy, seek medical assistance immediately. Do not try to self diagnose.

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