Treatment of cardiomyopathy (Heart Muscle Disease)

When the Cause of Heart Muscle Disease (dilated cardiomyopathy) is known, therapy is aimed at treatment of the underlying disorder, such as a curable infection or nutritional deficiency.

For example, in the case of Heart Muscle Disease Caused by Alcohol consumption, treatment entails total abstinence. Alcoholic cardiomyopathy is one of the few for which there exists a specific treatment, and patients with this type of Heart Muscle Disease have a good prognosis if they follow the prescribed treatment.

Because in most cases the cause of dilated cardiomyopathy is unknown, treatment focuses on relieving the symptoms and improving the function of the injured heart chambers.

Patients receive medications that enhance the contraction capacity of the heart muscle. The few drugs that produce this effect work indirectly, by increasing the level of calcium inside the heart cells. (Calcium initiates heart muscle contractions.) Digitalis and its derivatives such as digoxin (Lanoxin and others), the oldest and bestknown of such drugs, are usually administered orally but may, in some circumstances, be given by an intravenous injection.

More potent cardiac stimulants such as dobutamine (Dobutrex), dopamine (Intropin), and amrinone (Inocor), can be given only intravenously and are therefore primarily reserved for use in the hospital in more serious situations.

Oral forms of such medications are currently being developed. Diuretics are prescribed to relieve lung congestion and remove excess body fluid. Commonly referred to as "water pills", they facilitate the kidney's excretion of excess salt and fluid into the urine. While these drugs, which reduce congestion and swelling, are an essential part of heart failure therapy, patients can help the physician decrease the dosages of diuretics by limiting the amount of salt in their diet.

Function of the impaired heart can be significantly improved by altering the conditions under which it must work. Because the body responds to heart failure by constricting blood flow to all but the most vital organs, drugs that dilate blood vessels (vasodilators) reduce the work of the heart by decreasing resistance to bloodflow.

Angiotensin-converting enzyme (ACE) inhibitors, a class of vasodilators, are particularly effective in heart failure treatment. In the presence of an active inflammation in the heart (usually confirmed by heart biopsy), anti-inflammatory drugs such as steroids (cortisone) may be prescribed.

Although these medications have been extensively studied, it has not been proved whether they benefit patients with newly diagnosed dilated cardiomyopathy. In the early, acute stages of cardiomyopathy, when signs of heart inflammation and ongoing muscle injury are present, patients are told to rest. With covery from acute illness, they are advised to engage in regular physical activity to the extent that their heart function permits.

In extreme cases, when cardiomyopathy has progressed to the point when medical treatment can no longer relieve the symptoms, a heart transplant may be considered. Transplants increase life expectancy in persons with advanced heart failure who might otherwise be expected to live less than six months.

Currently, 80 to 90 percent of heart transplant recipients survive at least one year, and more than 75 percent survive five years. The scarcity of donor organs and the high level of sophisticated care required for a successful transplant make this option available only to a small number of patients-approximately 2,000 per year in the United States.