Cardiomyopathy is a group of diseases that affect the structure and function of the heart muscle, characterized primarily by decreased myocardial contractility or ventricular dilation, leading to impaired cardiac pumping function. There are many types of this disease, including dilated, hypertrophic, and restrictive cardiomyopathy, with dilated cardiomyopathy being the most common. Cardiomyopathy may be triggered by genetic, infectious, or environmental factors, and in severe cases, it can lead to heart failure, arrhythmias, or even sudden death.
Modern medicine has developed various diagnostic and treatment strategies for cardiomyopathy, including medication management, cardiac device implantation, and surgical interventions. Early diagnosis and proactive management can significantly slow disease progression and improve the quality of life for patients. This article will comprehensively analyze key information about cardiomyopathy, from its causes and symptoms to diagnostic methods, treatment, and prevention measures.
About 30% to 50% of dilated cardiomyopathy is associated with genetic mutations, with the most common genes including TNNI3, TNNC1, and LMNA. These genes are responsible for encoding proteins necessary for myocardial contraction, and mutations can lead to structural abnormalities in myocardial cells. Familial cardiomyopathy is typically inherited in an autosomal dominant manner, but the severity of the phenotype can vary from person to person.
Viral infections such as coxsackievirus or HIV can trigger myocarditis and progress to dilated cardiomyopathy. Long-term alcohol abuse or drug misuse (such as opioids or amphetamines) can also directly damage myocardial tissue. Additionally, chronic hypertension, coronary artery disease, or hemochromatosis (iron overload syndrome) can indirectly lead to structural abnormalities in the myocardium.
Patients who have undergone cardiac radiation therapy have a 10% to 20% chance of developing cardiomyopathy 5 to 10 years after treatment, and these patients require long-term monitoring of cardiac function.
Early-stage patients may experience only mild discomfort, with common manifestations including shortness of breath during exertion, occasional chest tightness, or palpitations. Some patients may feel difficulty breathing when lying flat (orthopnea), which is related to decreased cardiac pumping function leading to pulmonary congestion.
As the disease progresses to a moderate stage, patients may experience persistent fatigue, lower limb edema, abdominal bloating (portal hypertension phenomenon), and paroxysmal nocturnal dyspnea. Severe patients may exhibit arrhythmias, such as atrial fibrillation or ventricular tachycardia, increasing the risk of stroke or sudden death.
Echocardiography is the preferred diagnostic tool, capable of measuring the degree of ventricular dilation and contractile function indices (such as a left ventricular ejection fraction <35%, which meets diagnostic criteria). Cardiac magnetic resonance imaging (MRI) can more accurately assess the degree of myocardial fibrosis and regional motion abnormalities.
Electrocardiograms can capture signs of arrhythmias, such as QT prolongation or ST segment changes. Cardiac catheterization can evaluate coronary blood flow and ventricular pressures, aiding in the differential diagnosis of coronary artery disease. Blood tests showing elevated cardiac enzymes (such as troponin) indicate myocardial injury.
Angiotensin-converting enzyme inhibitors (ACEIs) and beta-blockers are foundational treatments; ACEIs can reduce ventricular afterload, while beta-blockers can decrease myocardial oxygen consumption. Diuretics are used to relieve edema, and anticoagulants (such as warfarin) are used to prevent stroke in patients with atrial dilation.
Cardiac resynchronization therapy (CRT) devices can improve issues with asynchronous ventricular contraction, while implantable cardioverter-defibrillators (ICDs) can address life-threatening arrhythmias in real-time. Patients with severe heart failure may require heart transplantation, with approximately 5% to 10% of end-stage patients globally needing this surgery each year.
A low-sodium diet (daily salt intake <2000 mg) can effectively control edema. Quitting smoking and limiting alcohol intake are crucial; studies show that consuming more than 30 grams of alcohol daily increases the risk of heart failure by three times. Regular aerobic exercise should be evaluated by a physician, typically recommended at an intensity of 60-70% of target heart rate for short-duration training.
Patients with hereditary cardiomyopathy should receive genetic counseling, and family members should undergo regular cardiac imaging screenings. Controlling metabolic diseases such as diabetes and hyperlipidemia can reduce the risk of developing cardiomyopathy. Vaccination against influenza and pneumonia can decrease the chances of infections that trigger myocarditis.
Seek immediate medical attention if experiencing persistent chest pain, unexplained weight gain of 2 kilograms within 24 hours, resting heart rate consistently exceeding 100 beats per minute, or shortness of breath during daily activities. If there is a history of heart disease and symptoms of angina or syncope occur, treat it as an emergency.
Even if symptoms occur intermittently (such as occasional dizziness or mild lower limb edema), prompt cardiac evaluation should be arranged. Physicians may recommend hospitalization for observation or 24-hour ECG monitoring to assess the risk of arrhythmias.
Patients with cardiomyopathy should avoid foods high in salt, fat, and sugar to reduce cardiac burden. It is recommended to increase the intake of deep-sea fish rich in Omega-3 fatty acids, high-fiber vegetables, and whole grains while controlling total caloric intake to maintain a healthy weight. If edema or hypertension is present, strict limits on daily salt intake are necessary, and regular discussions with a nutritionist about personalized dietary plans are advised.
What precautions should cardiomyopathy patients take when engaging in physical activities?Patients with cardiomyopathy should avoid vigorous exercise and high-intensity interval training, opting instead for low to moderate-intensity aerobic activities such as jogging, swimming, or yoga, and should do so only after physician evaluation. During exercise, monitoring heart rate and fatigue levels is essential; if chest pain, dizziness, or shortness of breath occurs, they should stop immediately and seek medical attention.
Is cardiomyopathy entirely caused by genetic factors?About 30-50% of cardiomyopathy is associated with genetic mutations, but many cases are triggered by acquired factors, such as chronic hypertension, cardiac infections, or metabolic diseases. Hereditary cardiomyopathy can be confirmed through genetic testing, but non-hereditary patients need treatment for the underlying disease, so a comprehensive assessment of the cause should be conducted after diagnosis.
Is it safe for cardiomyopathy patients to use herbal medicine or supplements?Some herbal medicines may interfere with the metabolism of cardiac medications or directly affect myocardial function; for example, ingredients containing ephedrine may induce arrhythmias. Patients must consult their physician before using any herbal medicines, vitamins, or supplements and disclose their current medication list to avoid drug interactions.
Can cardiomyopathy patients safely travel by plane?Patients with mild symptoms may travel short distances by plane with physician approval, but they should be aware that cabin dryness may induce thrombosis, so it is advised to stay hydrated and regularly move their limbs. Patients with severe heart failure or recent complications should avoid long-distance flights, carry medical documents, and inform the airline of their special needs in advance to ensure assistance in emergencies.
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