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 and normal.

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.

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 but does require routine monitoring.

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 to reduce 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 myectomy and may be a good option for older patients who have other medical problems.

Heart Transplantation

Heart disease that has progressed to heart failure may require a heart transplant. The transplant program at Duke 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.

Echocardiogram

An ultrasound of the heart creates images that allow doctors to see your heart’s structure.

Exercise Stress Test

Performed on a treadmill, this test evaluates how efficiently your heart works during exercise. 

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. 

Cardiac MRI

This sophisticated imaging technology uses magnetic energy to create images of your heart. It provides important information about the size and thickness of your heart muscle. It can also reveal scarring on your heart muscle, which may lead to abnormal heart rhythms. 

Genetic Counseling and Testing

Genetic testing in the form of a blood test can determine if you carry a gene linked to hypertrophic cardiomyopathy. If you do, there is a 50 percent chance that the gene will be passed on to your children. Our genetic counselors help family members learn about genetic testing and how to reduce their risk of heart disease.

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.