If you have cardiomyopathy but don’t have any symptoms, you may not need treatment. Some types that occur suddenly, such as dilated cardiomyopathy, may go away without treatment.
If your doctor recommends treatment, your treatment plan will depend on the type of cardiomyopathy you have, how serious it is, and whether you have any complications. Your doctor will discuss your treatment options with you to choose a treatment plan that works best for you.
Treatment for cardiomyopathy might not cure the problem with your heart. The main goals of treatment include:
- Controlling your symptoms so that you can have a good quality of life
- Managing any medical conditions that caused the cardiomyopathy
- Preventing serious problems, such as sudden cardiac arrest
- Stopping the disease from getting worse
Your treatment may include medicines, procedures, and devices. You may need to see a cardiologist, a doctor who specializes in diagnosing and treating heart disease.
The following medicines can help treat your symptoms. If your doctor prescribes a medicine, they have determined that the benefits outweigh the risks for your condition.
- Medicines to remove extra sodium and fluid from your body: These include diuretics and aldosterone antagonists. These medicines lower the amount of blood that the heart must pump. Very high doses of diuretics may cause low blood pressure, kidney disease, and worsening heart failure symptoms. Side effects of aldosterone antagonists can include kidney disease and high potassium levels.
- Medicines to relax your blood vessels and make it easier for your heart to pump blood: These include angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, and combination hydralazine/isosorbide dinitrate, which is used to treat heart failure in African Americans. Possible side effects include headaches, cough, low blood pressure, and kidney disease.
- Medicines to slow your heart rate, such as beta blockers, calcium channel blockers, and ivabradine: You may need one of these medicines if you have an irregular heartbeat (arrhythmia).These medicines make it easier for your heart to pump blood. Possible side effects include a slow or irregular heart rate, high blood pressure, and fuzzy vision or seeing bright halos. They can also make some arrhythmias worse.
- Medicines to balance your levels: These can help your heart work better. Side effects include kidney disease and high potassium levels in your blood.
- Blood thinners (anticoagulants): These medicines help prevent blood clots. The medicines can raise your risk of serious bleeding.
- Digoxin: This is used to treat a fast or irregular heartbeat. Digoxin can cause nausea, vomiting, and diarrhea. It may also cause some types of arrhythmias.
- Sodium-glucose cotransporter-2 (SGLT-2) inhibitors: These medicines are often used to treat diabetes but can also help your heart work better. Possible side effects include kidney disease and infections.
Procedures and implanted devices
Your doctor may talk to you about a procedure or device if medicines don’t help improve your symptoms.
Alcohol septal ablation
This procedure shrinks the septum (the muscle dividing the left and right lower chambers of the heart). This may help your heart work better. It is used only to treat hypertrophic cardiomyopathy blood vessel that supplies blood to the thickened part of your heart.
If your symptoms are serious, your doctor may have to remove part of your thickened septum to help your heart work better. This procedure is a type of heart surgery. It is used only to treat hypertrophic cardiomyopathy. You will be asleep during the procedure.
Catheter ablation is a procedure to stop abnormal electrical signals from moving through your heart and causing an irregular heartbeat.
Doctors perform catheter ablation in a hospital. Ablation is done through a procedure called cardiac catheterization that passes flexible tubes, or catheters, through your blood vessels until they reach your heart. Some catheters have wire electrodes that record and locate the source of your abnormal heartbeats. Other catheters can deliver treatments. Your doctor will aim the tip of a special catheter at the small area of heart tissue. A machine will send either radiofrequency (RF) waves, extremely cold temperatures, or laser light through the catheter tip to create a scar on the heart. The scar prevents abnormal electrical signals from causing irregular heartbeat.
Catheter ablation has some risks both during the procedure and during recovery, including:
- Blood vessel damage
- Heart damage
- Blood clots
There also may be a very slight risk of cancer from radiation used during catheter ablation. Talk to your doctor and the technicians performing the ablation about whether you are or could be pregnant.
Surgically implanted devices
If your cardiomyopathy causes other heart conditions, like an irregular heartbeat or heart failure, you may need a left ventricular assist device, an implantable cardioverter defibrillator, or a pacemaker.
You may need a heart transplant if you have life-threatening symptoms or complications of cardiomyopathy and all other treatments have not worked for you.
A heart transplant is surgery that removes a diseased heart and replaces it with a healthy heart from a deceased donor to improve your quality of life and increase your lifespan. Heart transplant surgery is a kind of open-heart surgery. It is done in a hospital under anesthesia.
After the surgery, you will recover in the hospital’s intensive care unit (ICU) and stay in the hospital for up to three weeks. During your recovery, you may start a cardiac rehabilitation program. Before leaving the hospital, you will learn how to keep track of your overall health; monitor your weight, blood pressure, pulse, and temperature; and learn the warning signs that your body may start rejecting your new heart. You will also learn to look out for early signs of an infection.
For the first three months after leaving the hospital, you will return often for tests to check for infection or rejection of your new heart, to see how well your heart is working, and to make sure that you are recovering well. You can help prevent complications after a heart transplant by practicing good hygiene, getting routine vaccines and dental care, and making healthy lifestyle choices.
Heart transplant has some serious risks.
- Primary graft dysfunction may occur. This happens when the donor heart fails and cannot function. It is the most common cause of death in the first month after heart transplant.
- Your immune system may reject your new heart. Rejection is most likely to occur within six months after the transplant. You will need to take medicines for the rest of your life to suppress your immune system and help prevent your body from rejecting your new heart. These medicines weaken your immune system and increase your chance for infection. Their long-term use also can increase your risk for cancer, cause diabetes and osteoporosis, and damage your kidneys.
- Cardiac allograft vasculopathy, a common and serious complication, may develop. This is an aggressive type of atherosclerosis, or build-up of plaque in the arteries, that over a few months or years can block the heart’s arteries and cause the donor heart to fail.
Over time, your new heart may fail due to the same reasons that caused your original heart to fail. Some patients who have a heart transplant that fails may be eligible for another transplant.
Despite these risks, heart transplant has a good success rate. Recent survival rates are about 85% at one year after surgery. Survival rates decrease by about 3% to 4% each extra year after surgery, mainly because of serious complications related to heart transplant.