Cardiomyopathy (Weak Heart) in Seniors
Cardiomyopathy is a disease of the heart muscles leading to weakening of the cardiac walls. There are three types of cardiomyopathy namely dilated, restrictive and hypertrophic. In cardiomyopathy the heart is unable to pump blood adequately to meet the needs of the body. There are various causes that can lead to cardiomyopathy and the condition more commonly develops in adults in the 30s and 40s. However, it can be a concern for the elderly as well managed cardiomyopathy from earlier in life may pose with complications by the senior years. The treatment options for cardiomyopathy are medication and surgery such as implantation of devices or a heart transplant.
Symptoms of Cardiomyopathy
Early and mild cases of cardiomyopathy usually do not produce any symptoms but with progression of the disease symptoms appear. Common symptoms are :
- Shortness of breath may occur with exertion. In advanced cases breathlessness can be precipitated with minimal or no activity (at rest).
- Accumulation of fluid in the dependent part of the body (legs, ankles and feet). In advanced cases generalized body swelling can occur (anasarca).
- Lethargy and weakness.
- Dizziness and lightheadedness.
- Fainting spells and sudden blackouts due to decreased blood supply to the brain.
- Irregular heartbeat, palpitation and “missed” beats.
Types of Cardiomyopathy
There are mainly three different types of cardiomyopathy which may be due to different causes.
- Dilated cardiomyopathy (most common) is where the heart muscles become progressively weak and the chambers become enlarged (dilated) compromising the capacity of the heart to pump blood adequately. Different co-existent medical conditions may lead to dilated cardiomyopathy.
- Restrictive cardiomyopathy is where there is stiffening of the heart muscles leading to incomplete filling of the chambers of the heart with blood. Amyloidosis (deposition of abnormal protein in the heart muscle) is the most common cause of this type of cardiomyopathy.
- Hypertrophic cardiomyopathy is where there is thickening of the heart muscle leading to difficulty in pumping blood to other body parts. This type of cardiomyopathy runs in the families.
There are two other less common types of cardiomyopathy.
- Ischemic cardiomyopathy due to narrowing of the arteries supplying the heart.
- Peripartum cardiomyopathy which may occur during pregnancy or within 5 months of delivery.
Causes and Risk Factors
The following are the causes that may lead to cardiomyopathy.It can be divided into primary where the problem lies in the heart itself or secondary where it develops as a consequence of other diseases.
Primary/intrinsic causes include:
- Genetic (present since birth): hypertrophic cardiomyopathy (HOCM), mitochondrial myopathy and so on.
- Acquired (later in life): takotsubo (stress induced) cardiomyopathy
- Mixed: dilated and restrictive cardiomyopathy
Secondary/extrinsic cardiomyopathy causes include:
- Metabolic: amyloidosis, haemochromatosis (iron overload)
- Inflammatory: Chagas disease (parasitic disease caused by trypanosomes)
- Hormonal problem: hypothyroidism, diabetes, acromegaly (increased amount of growth hormone)
- Toxicity: chronic alcoholism, drug induced
- Ischemia (poor blood flow)
- Family history
- Chemotherapeutic drug intake (doxorubicin)
- Chronic alcoholism
- Psychological stress, also known as “broken heart” syndrome, due to constant anxiety or death of loved ones.
The aims of treatment for cardiomyopathy are :
- Management of signs and symptoms.
- Preventing the worsening of the condition.
Different type of cardiomyopathy are treated in different ways.
- Drug therapy: angiotensin receptor inhibitors (ACE inhibitors), angiotensin receptor blocker (ARBs), beta blocker, diuretics (water pills).
- Implantation of a special pacemaker (ICD).
This type of cardiomyopathy is mostly treated with drugs (water pills).
- Drug therapy: beta blocker.
- Surgery: septal ablation, septal myectomy, implantation of pacemaker.