Cardiomyopathy

Cardiomyopathies, or diseases of the heart muscle, can occur without a known cause, be present without symptoms, and cause serious heart problems, including life-threatening arrhythmias, mitral valve disease, and heart failure. Identifying the disease early and working with cardiologists who are experts in its diagnosis and management will prevent cardiomyopathy from progressing and causing serious complications.

Duke cardiologists are experts in treating all types of cardiomyopathy.

Hypertrophic Cardiomyopathy
The most common type of cardiomyopathy occurs when the heart muscle wall thickens, making the heart work harder and sometimes obstructing the flow of blood leaving the heart. It often goes undiagnosed because many people have no or only mild symptoms. It is notorious for causing sudden death in young athletes but can affect people of all ages and activity levels. Hypertrophic cardiomyopathy may run in families.

Dilated Cardiomyopathy
The heart size is larger, but muscle walls are thinner and weaker than normal. This affects your heart’s ability to pump normally.

Restrictive Cardiomyopathy
This rare condition occurs when the lower chambers of the heart become rigid and stiff, which restricts filling of the heart during muscle relaxation. This also affects your heart’s ability to pump normally.

Your treatment is based solely on your unique condition. It may include one or more of the following options.

Medication

May be prescribed to manage arrhythmias, lower your blood pressure, and improve blood flow to the heart.

Implantable Cardioverter-Defibrillator (ICD)

If you are diagnosed with a life-threatening arrhythmia or have other risk factors, a battery-powered implantable cardioverter defibrillator (ICD) may be implanted under your skin. Thin wires placed within or near your heart muscle will continuously monitor your heart rhythm and may shock the heart back into rhythm if a life-threatening heart rhythm develops. This device offers a high level of protection against unpredictable heart rhythm abnormalities.

Septal Myectomy Surgery

Open heart surgery may be recommended if the muscular wall that separates the right and left sides of the heart -- called the septum -- thickens and bulges. This can restrict the heart’s ability to pump blood effectively out of the left ventricle to the body. During this procedure, a portion of the thickened septum is removed to relieve an obstruction. This procedure is used when medication alone isn’t effective in reducing severe symptoms such as shortness of breath that limits activity.

Alcohol Septal Ablation

When the thickening of your heart’s septum occurs in a small, defined area, our interventional cardiologists may use a catheter procedure to inject alcohol into the area. This leads to thinning of the muscle and fewer symptoms over a few months. This procedure is less invasive than septal myectomy surgery and may be a good option for older people who have other medical problems.

Ventricular Assist Device (VAD)

If cardiomyopathy has severely weakened your heart, leading to heart failure, you may be a candidate for a ventricular assist device (VAD). This mechanical heart pump can support your heart and optimize your blood flow while you’re waiting for a heart transplant. It can also be a long-term solution if you have heart failure and are not a candidate for a heart transplant. Today’s smaller, portable, more reliable heart pumps make VADs an option for more people.

Heart Transplant

Heart disease that has progressed to heart failure may require a heart transplant. Our transplant program is one of the nation’s largest and has been named one of the highest performing heart transplant centers in the country by the U.S. Department of Health and Human Services.

If hypertrophic cardiomyopathy is suspected, a thorough history and physical exam will be performed and diagnostic tests may be ordered, including one or more of the following.

Electrocardiogram (ECG)

Small electrodes are placed on your skin to record your heart’s electrical impulses. The tracings may help identify risk for or prior heart muscle damage.

Holter Monitor

A battery-operated, portable device records your heart’s electrical signal for days or weeks to determine if you have abnormal heart rhythms.

Stress Test

A stress test is an ECG that’s performed while you walk on a treadmill or ride a bike, or when a chemical is used to stimulate your heart. A stress test is used to monitor changes in your heart’s function when it’s under stress that may indicate coronary artery disease.

Echocardiogram

An ultrasound probe is moved over the surface of your chest to capture moving images of your heart. This allows us to determine your heart’s chamber dimensions, shape, valve structures, and overall function.

Stress Echocardiogram

A stress echocardiogram is performed while you walk on a treadmill or ride a bike, or when a chemical is used to stimulate the heart. A stress echocardiogram is used to monitor changes in your heart’s function while it’s under stress that may indicate coronary artery disease.

3-D Transesophogeal Echocardiogram

An ultrasound probe passed through your esophagus is used to capture sound waves that create highly detailed, close-up 3-D images of your heart’s chamber dimensions, shape, valve structures, and overall function.

Cardiac Catheterization

Flexible catheters are guided through a blood vessel to your heart to look for blockages and overall heart function. Contrast dye is injected and X-rays are taken to capture images of your heart, coronary arteries, and other blood vessels.

CT Coronary Angiography

A contrast agent is injected into your arm and a CT scan produces highly detailed 3-D images of your coronary arteries to help identify anatomy and blockages.

Cardiac MRI

Radio waves, magnets, and a computer create still and moving images of your overall heart structure, heart muscle function, blood vessels, and surrounding structures.

Nuclear Cardiac Testing

Radioactive dye is used during imaging to create pictures of blood flow through your heart. This test may be done at rest or with exercise. It helps to evaluate overall heart function.

Skilled Experts
Our cardiologists are experts in managing cardiomyopathy and work with other Duke cardiologists who are specialists in the related heart problems that can arise. Our experienced heart surgeons and interventional cardiologists perform procedures to remove obstructions that may result from the thickening of the heart muscle or treat problems of the mitral valve.

Advanced Imaging Techniques
We use heart imaging techniques such as cardiac MRI to diagnose cardiomyopathy and confirm its type. Our heart imaging experts' use of and skill with advanced imaging also helps us define the location and extent of related heart problems.

Clinical Trials
As a Duke patient, you may be eligible to participate in clinical trials that offer access to new therapies, procedures, or devices that aren’t widely available.

Options for Heart Rhythm Treatment
If a heart rhythm disorder is suspected, our electrophysiologists can recommend a range of treatment options, from medications to implanted defibrillators to surgery.

Specialized Care for Expectant Moms
Our maternal-fetal medicine experts help women with hypertrophic cardiomyopathy manage heart issues during pregnancy.