Cardiomyopathy Treatment

Cardiomyopathies, diseases of the heart muscle, can occur with or without a known cause, can be present without signs or symptoms, and can 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 can help prevent cardiomyopathy from progressing and causing serious complications.

Choosing the right treatment depends on the type of cardiomyopathy you have. Duke cardiologists are experts in diagnosing and treating all types of cardiomyopathy.

Hypertrophic Cardiomyopathy
The most common type of cardiomyopathy occurs when the heart muscle wall thickens. This forces the heart to work harder and sometimes restricts the flow of blood leaving the heart (called outflow obstruction). It often goes undiagnosed because many people have no or only mild symptoms. It has been tied to sudden death in young athletes, but it can affect people of all ages and activity levels. Hypertrophic cardiomyopathy may have a genetic cause.

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

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

Medication
Medication may be prescribed to treat symptoms, manage arrhythmias, and slow the disease.  

Alcohol Septal Ablation 
In people with hypertrophic cardiomyopathy and outflow obstruction, our interventional cardiologists may be able to use a catheter procedure to inject alcohol into the obstructed area. The alcohol causes the heart muscle to thin, reducing symptoms over a few months. This procedure is less invasive than traditional surgery and may be a good option for older people who have other medical problems.

Implantable Cardioverter-Defibrillator (ICD)
A battery-powered ICD offers protection against unpredictable arrhythmias. The device is surgically implanted under your skin. Thin wires placed within or near your heart muscle continuously monitor your heart rhythm and can pace or shock the heart back into rhythm if a life-threatening arrhythmia develops. This device is recommended for people with certain types of cardiomyopathy and who have certain risk factors, such as extremely thick heart muscle or severely reduced heart strength.

Ventricular Assist Device (VAD)
If cardiomyopathy has severely weakened your heart, leading to heart failure, you may be a candidate for a 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.

Septal Myectomy
This open-heart surgery aims to remove thickened heart muscle in people with hypertrophic cardiomyopathy with outflow obstruction and severe symptoms. During this procedure, a portion of the thickened septum (the wall that divides the heart’s two sides) is removed to thin the muscle and open up the obstructed area. This procedure is used when medication alone isn’t effective in reducing severe symptoms, such as shortness of breath, that limit activity. Mitral valve problems can be treated during the same surgery.

Heart Transplant
Heart disease that has progressed to heart failure may require a heart transplant. Our heart transplant and advanced heart failure programs are some of the nation’s largest. We use advanced techniques to find more quality, viable donor hearts for more people in need.

If cardiomyopathy is suspected, our heart specialists will take a thorough history and perform a physical exam. Other 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 and rhythms.

Holter Monitor
A battery-operated, portable, and wearable heart monitor records your heart’s electrical signal from your home for days or weeks to identify abnormal heart rhythms.

Stress Test
Also known as a cardiopulmonary exercise or CPX test, a stress test is an ECG that’s performed while you exercise on a treadmill or stationary bike. This test helps identify causes of breathlessness, measure a person’s exercise capacity, and determine why exercise capacity may be reduced.  

Echocardiogram
An ultrasound probe is moved over the surface of your chest to capture moving images of your heart using sound waves. This allows doctors to determine your heart’s chamber dimensions, wall thickness, shape, valve structures, and overall strength.

Stress Echocardiogram
A stress echocardiogram is performed while you walk on a treadmill or ride a stationary bike, or when a chemical is used to stimulate the heart. Like a traditional stress test, a stress echo helps identify changes in your heart’s function during exertion. In people with hypertrophic cardiomyopathy, this test may help determine whether outflow obstruction during exercise could be causing symptoms.

Transesophogeal Echocardiogram (TEE)
A thin ultrasound probe is put down your throat and into your esophagus. It uses sound waves to create highly detailed, 3D images of your heart. This test can show the inside of the heart and its valves more clearly that a traditional echocardiogram.

Cardiac Catheterization
A thin, long, hollow tube is inserted into a large blood vessel and guided through your circulatory system to your heart. A heart catheterization helps measure pressures in the heart and lungs and look for any blockages in the coronary arteries, which supply the heart with oxygen. Contrast dye is sometimes injected so that blood vessels (and any blockages or narrowed areas) appear on X-rays.

CT Coronary Angiography
A contrast agent is injected into a vein in your arm and then a CT scan produces highly detailed 3D images of your coronary arteries to help identify anatomy and blockages. This test can also be helpful to look at other blood vessels in the heart, lungs, and heart valves.

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 while at rest or with exercise. It helps to evaluate overall heart function and blood flow to the heart muscle.

Skilled Experts
Our cardiologists are experts in managing cardiomyopathy, and we work with other Duke specialists to treat related heart problems that can arise. Our experienced heart surgeons and interventional cardiologists perform procedures to remove obstructions that may result when the thickening of heart muscle causes blood to rush forcefully through your heart valves. This can lead to mitral valve disease.

Genetic Heart Disease Testing
Duke is one of the only centers in the Southeast with experts who can administer and interpret complex tests that identify or confirm diagnoses of rare types of genetic cardiomyopathies, including hypertrophic, arrhythmogenic right ventricular, left ventricular non-compaction, dilated, and restrictive cardiomyopathies. Comprehensive genetic testing and counseling can help determine whether your cardiomyopathy is genetic, pinpoint the best treatment approaches for you, and identify family members who may be at risk.

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

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

Options for Arrhythmias
If an arrhythmia is suspected, our electrophysiologists can recommend a range of treatment options, including medications, implanted devices, or surgery.

Specialized Care for Expectant Moms
Our perinatologists help women with hypertrophic cardiomyopathy manage heart issues during pregnancy.