Questions about cardiomyopathy.

    
      Re: Questions about cardiomyopathy.
    


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Posted by CCF CARDIO MD - HSB on October 30, 1997 at 09:37:17:

In Reply to: Questions about cardiomyopathy. posted by Carrie Casanova on October 20, 1997 at 00:34:20:

: Dear Doctors,
          I am a 28 yr old female and I was just diagnosed with cardiomyopathy. I am making an appointment with a different cardiologist because the one that I had did not want to answer my questions and told me not to worry about the c-myopathy because I'm so young.  Is this a valid statement?  Is there an "age range" for cardiomyopathy?  She suggested that I could have a viral infection in my heart but would not answer my questions about how and why this could happen.  What is a viral infection of the heart?  How does one get this infection?  What methods are used to treat it?  If I do indeed have secondary cardiomyopathy because of a virus, will it go away if the virus goes away?  What are the chances of this reoccuring if it does?  Another disturbing thing was that I was told that cardiomyopathy doesn't cause angina and that I probably wasn't having angina (although I exhibit classic symptoms of angina).  Yet everything that I read says that it does cause angina.  What is the correct answer?  
         Thank you for your time and for helping me in my confusion.  I anxiously await a second opinion, but in the meantime your answers to my questions will help calm some fears.  
  Sincerely,
  Carrie Casanova
_______
Dear Carrie:
The term "cardiomyopathy" literally means disease of heart muscle. Numerous disease processes can result in "cardiomyopathy".   The most common causes of cardiomyopathy in the United States include
idiopathic (secondary to an unknown or unproven cause),  infectious (i.e. viral - often difficult to prove thus often classified as idiopathic); hypertrophic (abnormal thickening of the heart muscle),  & toxic  (due to alcohol and other poisons).  Heart muscle dysfunction secondary to coronary artery disease, hypertension and valvular disease are also classified as cardiomyopathy ( ischemic, hypertensive and valvular cardiomyopathy).  As you can see this term defines a syndrome of heart muscle dysfunction which can be due to a number of diverse causes.  Treatment is dependent on the underlying etiology and the symptoms the patient is experiencing.
Unfortunately, heart disease affects the old as well as the young.  Certain disease processes are more prevalent in specific subsets of the population.  For example, ischemic heart disease generally afflicts middle aged patients who have developed coronary artery disease.
"Viral" cardiomyopathy is a diagnosis many cardiologists consider when no other cause of heart muscle dysfunction can be identified despite a complete medical evaluation.  The exact pathophysiology is poorly understood and treatment is generally directed at the patients symptoms.  No specific treatments have been proven to be effective.  However, the use of medications such as ACE  inhibitors (angiotensin converting enzyme inhibitors) have been shown to improve symptoms and prolong the life expectancy of patients with heart muscle dysfunction due to a number of causes.   Prognosis varies as  a significant number of patients (30-40%) improve spontaneously while the rest either stabilize or deteriorate.
I  hope that this information is useful.  I would suggest that you seek a second opinion so that an accurate diagnosis can be made and appropriate treatment instituted.  If you would like to be evaluated at the Cleveland Clinic, an appointment  with one of our cardiologist can be made by calling 1-800-CCF-CARE.