DR MILES DALBY
MBBS BSc MD FRCP FESC
The term cardiomyoapthy is used to describe intrinsic disease of the heart muscle, in particular the left ventricle of the heart. The ventricles of the heart can be damaged by extrinsic causes such as heart attacks from blockages of the coronary arteries (known as ischaemic cardiomyopathy) however this section deals with intrinsic diseases of the muscle where no obvious extrinsic cause can be found.
Two of the two most important intrinsic cardiomyoapthies are dilated cardiomyopathy (DCM) and hypertophic cardiomyopathy (HCM or HOCM)
DCM results in weakening and enlargement of the left ventricle of the heart which can go on to produce symptoms of breathlessness and heart failure. Sometimes it will be necessary to recommend a myocardial biopsy to understand the cause. Drug therapy can be very effective in the treatment of DCM and in some cases an implantable defibrillator (ICD) may be recommended to protect the patient from dangerous heart rhythms.
HCM/HOCM describes asymmetrical hypertropy (thickening) of the left ventricular muscle of the heart in an area known as the septum. Drug therapy can sometimes be effective for the complications of HCM/HOCM and in some cases an implantable defibrillator (ICD) may be recommended to protect a patient from dangerous heart rhythms. In patients with complications from obstruction to blood flow due to muscle thickening, on some occasions surgery or trans catheter ‘ablation’ techniques can be used to improve the blood flow.
When investigating possible cardiomyopathy in the clinic your cardiologist will need to take history and perform a physical examination. In addition they will want to perform some tests which will often include blood tests, a chest x-ray, ECG, and echocardiogram. Further tests to exclude significant coronary artery disease such as CT coronary angiogram, myocardial perfusion scan, stress echo or a coronary angiogram may be necessary. Sometimes a biopsy of the heart may be helpful. If a hereditary problem is suspected screening of relatives may be advised, and genetic testing may be reccomended.
Dr Dalby will discuss these tests, their implications and any subsequent tests, treatment or follow up with you so that you may reach a mutually agreeable management plan.