How to treat ischemic cardiomyopathy? Causes, symptoms, and prognosis

By: Dr. Victor Marchione | Heart Health | Monday, August 07, 2017 - 07:00 AM

ischemic cardiomyopathyIschemic cardiomyopathy may be a difficult concept to wrap your head around, but essentially, it’s a term used to describe patients whose heart can no longer pump blood efficiently throughout the rest of body. Ischemic cardiomyopathy often occurs as a result of narrowing blood vessels of the heart restricting vital heart muscle from oxygen-rich blood. This results in heart cells becoming damaged or dying off permanently.

What are the causes and symptoms of ischemic cardiomyopathy?

The heart is arguably one of the body’s most important organs. It pumps nearly 2,000 gallons or 7,500 liters of blood every single day. This amount of blood being circulated is absolutely necessary to adequately provide all the tissues and organs with the oxygen and nutrients needed to survive. Ischemic cardiomyopathy decreases the heart’s ability to achieve this. It often causes the left ventricle—the “work house” of the heart—to become weakened, dilated, and enlarged.

The primary cause of ischemic cardiomyopathy is coronary artery disease. This condition develops due to the build-up of a hard substance called plaque within the arteries themselves, leading to their decreased flexibility and a narrowed lumen. Coronary artery disease does not occur over night, but over a long period of time. When the coronary arteries reach a point where blood flow is significantly restricted, it can lead to angina—a form of chest pain that causes heart attack. Ischemic cardiomyopathy is the result of such events and often leads to heart failure.

Conditions that ultimately lead to the development of ischemic cardiomyopathy include:

  • Family history of heart disease
  • High blood pressure (hypertension)
  • High cholesterol
  • Obesity
  • Diabetes
  • End stage kidney disease
  • Amyloidosis, a condition in which abnormal proteins build up in your tissues and organs
  • Sedentary lifestyle
  • History of smoking
  • Alcohol or drug abuse

Symptoms of ischemic cardiomyopathy often include:

  • Extreme fatigue
  • Shortness of breath
  • Dizziness, lightheadedness, or fainting
  • Chest pain and pressure (angina)
  • Heart palpitations
  • Swelling in your legs and feet (edema)
  • Swelling in your abdomen (ascites)
  • Cough or congestion, caused by fluid in your lungs
  • Difficulty sleeping
  • Weight gain

How to diagnose ischemic cardiomyopathy?

Ischemic cardiomyopathy diagnosis is, unfortunately, one that is reached after a cardiac muscle damaging event has already occurred, like a heart attack. Due to this fact, your heart is not pumping as efficiently as it once did. A test is often used to measure the ejection fraction of the heart—the percentage of blood that is ejected out the heart with each contraction. The following tests may aid in this measurement or provide additional evidence for an ischemic cardiomyopathy diagnosis.

  • X-ray, CT, or MRI to examine the internal tissues
  • Electrocardiogram (EEG) records the electrical activity of the heart
  • Echocardiogram uses sound waves to evaluate heart function
  • Treadmill stress test uses to monitor the heart’s activity during exercise
  • Cardiac catheterization/coronary angiography looks directly at how narrow the heart vessels are
  • Myocardial biopsy, a sample collected from the heart muscle to be analyzed under microscope

Treating ischemic cardiomyopathy

Due to the fact that the most common underlying cause of ischemic cardiomyopathy is coronary artery disease, preventing its occurrence is a major treatment modality for preventing ischemic damage to the heart in the first place. If ischemic damage has already occurred, various other treatment pathways can be taken to help the patient manage their heart failure symptoms.

Lifestyle changes: To help lower your risk of complications, eating a healthy diet that is low in saturated fats, cholesterol, and sodium goes a long way in helping prevent coronary artery disease development. Exercise in a manner that doesn’t excessively strain the heart will also help reduce your risk. The avoidance of smoking cigarettes and drinking excessive amounts of alcohol are already recommended. The only way for these lifestyle changes to have a significant impact on your heart health is to make them a part of your everyday life.

Medications: The use of prescribed heart medication can help reduce the workload of the heart, which decreases the chances of causing it damage. Certain medications can also be used to improve heart function depending on your particular circumstance. Cardiac medication may include:

  • Beta-blockers – reduce blood pressure and heart rate
  • Calcium channel blockers – relax and widen arteries and lowers blood pressure
  • Aldosterone inhibitors – help lower blood pressure and aid in the elimination of edema
  • Diuretics – helps to eliminated excess fluid, lowers blood pressure, and reduces the amount of work need to be done by the heart
  • Blood thinners – help prevent the development of blood clots
  • Medications to control heart rate and rhythm

Surgery and other procedures: In more severe cases of ischemic cardiomyopathy, that that is not controlled by medication alone, more invasive methods of treatment will be required. These may include:

  • Implantable pacemaker or defibrillator, or even both
  • Angioplasty – to open narrowed arteries and place a stent to keep it open
  • Radiation therapy – to keep arteries clear after angioplasty
  • Atherectomy – a minimally invasive procedure for removing plaque from blood vessels

Prognosis and prevention of ischemic cardiomyopathy

Ischemic cardiomyopathy prognosis depends on the amount of damage sustained to the heart, how effective the prescribed treatment is, and whether cardioprotective lifestyle choices are being adhered to. Also, if treatment is not sought out in a prompt manner, untreated ischemic cardiomyopathy can lead to blood clot development, heart failure, or even death.

How well you do after being diagnosed with ischemic cardiomyopathy also very much depends on you. Are you avoiding bad habits such as smoking or excessive drinking? Are you performing appropriate follow-up care? are you successfully managing other health condition you already have?

Preventing ischemic cardiomyopathy may making healthy life choices is by far the best way to ensure good heart health. By maintaining a healthy weight, monitoring blood pressure and cholesterol levels, and getting a healthy diet low in saturated fats, cholesterol, and sodium, you will be on track to protect your heart.

By practicing a daily routine of healthy habits, you can lower your risk of developing coronary artery disease. It is important to keep in mind that despite having some control over your heart health, only by visiting a doctor will you be able to fully assess how much you are at risk for developing ischemic cardiomyopathy.


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Related Reading:

Enlarged heart (cardiomegaly): Causes, symptoms, diagnosis and treatment

Understanding microvascular ischemic disease: Causes, symptoms, and treatment

Sources:

http://www.nytimes.com/health/guides/disease/ischemic-cardiomyopathy/overview.html
https://my.clevelandclinic.org/health/articles/ischemic-cardiomyopathy
https://www.aarpmedicareplans.com/health/ischemic-cardiomyopathy

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