Treatment

Not everyone with cardiomyopathy needs treatment. People who have no symptoms may not need treatment. In some cases, dilated cardiomyopathy that comes on suddenly may even go away on its own. For other people with cardiomyopathy, treatment is necessary.

Specific treatments depend on the type of cardiomyopathy, how severe the symptoms and complications are, and the age and overall health of the person.

Goals of Treatment

The main goals of treating cardiomyopathy are to:

• Manage any conditions that cause or contribute to the cardiomyopathy
• Control symptoms so that the person can live as normally as possible
• Stop the disease from getting worse
• Reduce complications and the chance of sudden cardiac death

Specific Types of Treatment

Treatments for cardiomyopathy may include medicines, surgery, nonsurgical procedures, and lifestyle changes.

Medicines

A number of medicines may be used to treat cardiomyopathy, including:

• Diuretics, which remove excess fluid and sodium from the body.
• Angiotensin-converting enzyme (ACE) inhibitors, which lower blood pressure and reduce stress on the heart.
• Beta-blockers, which slow the heart rate by reducing the speed of the heart's contractions. These medicines also lower blood pressure.
• Calcium channel blockers, which slow a rapid heartbeat by reducing the force and rate of heart contractions. These medicines also lower blood pressure.
• Digoxin, which increases the force of heart contractions and slows the heartbeat.
• Anticoagulants, which prevent blood clots from forming. Anticoagulants are often used in the treatment of dilated cardiomyopathy.
• Antiarrhythmia medicines, which keep the heart beating in a normal rhythm.
• Antibiotics, which are used before dental or surgical procedures. Antibiotics help to prevent endocarditis, an infection of the heart walls, valves, and vessels.
• Corticosteroids, which reduce inflammation.

Surgery

Doctors can use several different types of surgery to treat cardiomyopathy, including removing part of the enlarged heart muscle (septal myectomy) and implanting devices that help the heart beat more effectively. Heart transplant is sometimes used in cases of severe heart failure.

Septal myectomy. Septal myectomy (also called septal myomectomy) is open-heart surgery for people with hypertrophic obstructive cardiomyopathy and severe symptoms. It is generally used in younger patients and when medicines aren't working well.

In septal myectomy, a surgeon removes part of the thickened septum that is bulging into the left ventricle. This widens the pathway in the ventricle that leads to the aortic valve and improves blood flow through the heart and out to the body. The tissue that is removed does not grow back. If necessary, the mitral valve can be repaired or replaced at the same time. This surgery is often successful, and the person can return to a normal life with no symptoms.

Surgically implanted devices. Surgeons can place several different types of devices in the heart to help it beat more effectively. One device is a pacemaker, which electronically helps maintain normal heart rhythm. Sometimes, doctors choose to use a biventricular pacemaker, which coordinates contractions between the heart's left and right ventricles.

A left ventricular assist device (LVAD) helps the heart pump blood to the body. LVAD can be used as a long-term therapy or as a short-term treatment for people who are waiting for a heart transplant.

An implantable cardioverter defibrillator (ICD) is used in people who are at risk of life-threatening arrhythmia or sudden cardiac death. This small device is implanted in the chest and connected to the heart with wires. If the ICD senses a dangerous change in heart rhythm, it will send an electric shock to the heart to restore a normal heartbeat.

Heart transplant. In this surgery, a doctor replaces a person's diseased heart with a healthy heart from a person who has recently died. It is a last resort for people with heart failure when all other treatments have failed.

Nonsurgical Procedure

Alcohol septal ablation. In this procedure, a doctor injects ethanol (a type of alcohol) through a catheter into the small artery that supplies blood to the thickened area of heart muscle. The alcohol kills the cells and the thickened tissue shrinks to a more normal size. Blood can flow freely through the pathway in the ventricle that leads to the aortic valve, and symptoms improve.

Lifestyle Changes

The doctor may recommend lifestyle changes to manage a condition that is causing the cardiomyopathy. These changes may help reduce symptoms. Lifestyle changes may include:

• Quitting smoking
• Losing excess weight
• Eating a low-salt diet
• Getting moderate exercise, such as walking, and avoiding strenuous exercise
• Avoiding the use of alcohol and illegal drugs
• Getting enough sleep and rest
• Reducing stress
• Treating underlying conditions, such as diabetes and high blood pressure  

Reference:

National Heart, Lung, and Blood Institute, USA.