Cardiomyopathy is a term used to describe diseases of the heart muscle. In these conditions, the heart muscle becomes abnormal in structure or function, which can affect how well the heart pumps blood around the body. Cardiomyopathy is not a single condition but a group of related disorders with different causes, patterns, and outcomes.
Many people are unfamiliar with it until it is mentioned during an investigation. Hearing the term can be worrying, but the condition varies widely in severity. Some forms are mild and stable, while others require closer monitoring or treatment. Understanding what it is helps place the diagnosis into context and supports informed decision making.
How the heart muscle normally works
The heart muscle contracts in a coordinated way to pump blood to the lungs and the rest of the body. For this to happen efficiently, the muscle needs to be strong, flexible, and well coordinated with the heart’s electrical system.
Cardiomyopathy affects the muscle itself. This can lead to reduced pumping ability, stiffness that limits filling, or abnormal thickening of the muscle. The effects depend on the type of cardiomyopathy and how advanced it is.
Common types of cardiomyopathy
There are several recognised types of cardiomyopathy. Each affects the heart muscle in a different way.
Dilated cardiomyopathy
Dilated cardiomyopathy occurs when the heart muscle becomes weakened and the main pumping chamber enlarges. As the chamber stretches, it becomes less effective at pumping blood.
This form can develop for many reasons, including previous viral infections, excessive alcohol intake, certain medications, or long standing high blood pressure. In some cases, no clear cause is found.
Symptoms may include breathlessness, fatigue, reduced exercise tolerance, and ankle swelling. However, some people have few or no symptoms in the early stages.
Hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy is characterised by abnormal thickening of the heart muscle. This thickening can interfere with blood flow out of the heart or impair relaxation of the muscle.
It is often inherited and may run in families. Many people with hypertrophic cardiomyopathy remain symptom free, while others experience breathlessness, chest discomfort, palpitations, or dizziness.
This condition is an important cause of heart problems in younger people and athletes, which is why family history is particularly relevant.
Restrictive cardiomyopathy
Restrictive cardiomyopathy is less common. In this condition, the heart muscle becomes stiff rather than weak, making it difficult for the heart to fill properly between beats.
The pumping strength may be preserved, but symptoms can still occur due to raised pressures within the heart. Causes include certain infiltrative diseases and scarring of the heart muscle.
Arrhythmogenic cardiomyopathy
Arrhythmogenic cardiomyopathy primarily affects the electrical stability of the heart. Parts of the heart muscle are replaced by fatty or fibrous tissue, increasing the risk of abnormal heart rhythms.
This form is often inherited and may present with palpitations, blackouts, or rhythm disturbances, sometimes before any pumping problem is detected.
Causes of cardiomyopathy
The causes of cardiomyopathy vary depending on the type. Some forms are inherited, meaning they are linked to genetic changes passed down through families. Others develop due to acquired factors.
Common contributing factors include viral infections, long standing high blood pressure, heart valve disease, excessive alcohol consumption, and certain systemic illnesses. In many cases, particularly with dilated cardiomyopathy, no single cause is identified. Understanding the likely cause helps guide management and informs whether family members should be assessed.
Symptoms of cardiomyopathy
Symptoms depend on the type and severity of it. Some people have no symptoms and are diagnosed incidentally during tests performed for other reasons.
When symptoms occur, they may include breathlessness, fatigue, reduced exercise tolerance, chest discomfort, palpitations, dizziness, or ankle swelling. These symptoms are not specific to cardiomyopathy and can overlap with many other conditions, which is why careful assessment is important. Symptoms may develop gradually or appear suddenly, depending on the underlying process.
How it is diagnosed
Diagnosis usually begins with a detailed history and examination, including questions about symptoms, family history, and potential contributing factors. Echocardiography is central to diagnosis. It allows assessment of heart muscle thickness, chamber size, pumping function, and valve performance. ECGs are also commonly used to identify rhythm abnormalities or electrical changes.
In some cases, further tests such as cardiac MRI, blood tests, exercise testing, or genetic assessment are helpful to clarify the diagnosis and guide management.
Cardiomyopathy and heart rhythm problems
Abnormal heart rhythms are common in people with cardiomyopathy. These can range from occasional extra beats to more sustained rhythm disturbances.
The presence and type of arrhythmia influence both symptoms and treatment decisions. Monitoring is often used to assess rhythm behaviour, particularly when palpitations or blackouts are reported. Managing rhythm problems is an important part of cardiomyopathy care and may involve medication or other interventions.
Treatment and management
Treatment depends on the type of cardiomyopathy, symptom severity, and how the heart is functioning. Not everyone with it needs active treatment beyond monitoring. Management may include medication to support heart function, control symptoms, or reduce the risk of complications. Lifestyle advice is also important and is tailored to the individual.
In some cases, devices such as pacemakers or defibrillators are recommended to manage rhythm problems or reduce risk. More advanced treatments are considered when symptoms progress despite standard care. The aim is always to match treatment to need and avoid unnecessary intervention when the condition is stable.
Long term outlook
The outlook for cardiomyopathy varies widely. Many people live full and active lives with minimal limitation, particularly when the condition is detected early and managed appropriately.
Regular follow up allows changes to be identified and treatment adjusted if required. Even when cardiomyopathy is more significant, modern management has improved outcomes considerably.
Reassurance and perspective
Being told you have cardiomyopathy can feel unsettling, particularly if the diagnosis is unexpected. It is important to remember that cardiomyopathy is a broad term and does not imply a single outcome. Assessment focuses on understanding what the diagnosis means for you as an individual rather than relying on labels alone.
If you would like to discuss cardiomyopathy or understand test results in more detail, you can get in touch with me to arrange an assessment and talk through your situation in a clear and measured way.