A cardiomyopathy is a primary disorder of the heart muscle. It is distinct from structural cardiac disorders such as coronary artery disease, valvular disorders, and congenital heart disorders. Cardiomyopathies are divided into 3 main types based on the pathologic features (see figure ):
The term ischemic cardiomyopathy refers to the dilated, poorly contracting myocardium that can occur in patients with severe coronary artery disease Overview of Coronary Artery Disease Coronary artery disease (CAD) involves impairment of blood flow through the coronary arteries, most commonly by atheromas. Clinical presentations include silent ischemia, angina pectoris, acute... read more (with or without areas of infarction). It is not classically considered to be in the above-listed categories because it does not describe a primary myocardial disorder.
Manifestations of cardiomyopathies are usually those of heart failure Pathophysiology Heart failure (HF) is a syndrome of ventricular dysfunction. Left ventricular (LV) failure causes shortness of breath and fatigue, and right ventricular (RV) failure causes peripheral and abdominal... read more and vary depending on whether there is systolic dysfunction Heart failure with reduced ejection fraction (HFrEF) Heart failure (HF) is a syndrome of ventricular dysfunction. Left ventricular (LV) failure causes shortness of breath and fatigue, and right ventricular (RV) failure causes peripheral and abdominal... read more , diastolic dysfunction Heart failure with preserved ejection fraction (HFpEF) Heart failure (HF) is a syndrome of ventricular dysfunction. Left ventricular (LV) failure causes shortness of breath and fatigue, and right ventricular (RV) failure causes peripheral and abdominal... read more , or both. Some cardiomyopathies may also cause chest pain Chest Pain Chest pain is a very common complaint. Many patients are well aware that it is a warning of potential life-threatening disorders and seek evaluation for minimal symptoms. Other patients, including... read more , syncope Syncope Syncope is a sudden, brief loss of consciousness with loss of postural tone followed by spontaneous revival. The patient is motionless and limp and usually has cool extremities, a weak pulse... read more , arrhythmias Overview of Arrhythmias The normal heart beats in a regular, coordinated way because electrical impulses generated and spread by myocytes with unique electrical properties trigger a sequence of organized myocardial... read more , or sudden death.
Evaluation typically includes family history, blood tests, ECG Electrocardiography The standard electrocardiogram (ECG) provides 12 different vector views of the heart’s electrical activity as reflected by electrical potential differences between positive and negative electrodes... read more , chest x-ray, echocardiography Echocardiography Echocardiography uses ultrasound waves to produce an image of the heart, the heart valves, and the great vessels. It helps assess heart wall thickness (eg, in hypertrophy or atrophy) and motion... read more , and cardiac MRI Magnetic Resonance Imaging (MRI) in Cardiac Diagnosis Cardiac imaging tests can delineate cardiac structure and function. Standard imaging tests include Echocardiography Chest x-ray Computed tomography (CT) Magnetic resonance imaging (MRI) read more . Some patients require endomyocardial biopsy. Other tests are done as needed to determine the cause. Treatment depends on the specific type and cause of cardiomyopathy (see table ).
Forms of Cardiomyopathy