HEART FAILURE AND CARDIOMYOPATHY

The term heart failure sounds dramatic, and patients can be scared when talking about this condition. As doctors, we recognise different sorts of heart failure. Most typically, we see patients with dilated and weakened heart muscle which no longer pumps the blood forwards round the body with sufficient efficiency to cope with the demands of the body. In early stages, symptoms may be on significant exertion only, but many cases can progress to breathlessness at rest. Other symptoms of heart failure include swelling up of the ankles and legs (oedema); lethargy, tiredness, and heart rhythm disturbances.

Some cases of heart failure are caused by coronary artery disease, some by hypertension, and some from a condition called Dilated Cardiomyopathy (DCM), which can run in certain families, can be a response to alcohol consumption, or can be present without an identifiable cause.

Some patients have heart failure from heart valve problems needing valve replacement. We also see some patients with thickened or stiff heart muscle which can cause similar symptoms, so called diastolic heart failure, even though the pumping function may appear to be normal.

Investigations can include echocardiogram, cardiac MRI, cardiac catheterisation, heart rhythm monitoring.

In each case, the specific treatment may be different, and an accurate diagnosis of the cause of the heart failure syndrome is required.

Treatment will almost certainly start with careful drug therapy, especially so-called ACE inhibitors, beta-blockers and often diuretic tablets, so-called ‘water pills’.

Selected patients with heart failure may also need, depending on their underlying problems, heart valve replacement, coronary angioplasty, coronary artery bypass grafting, implantable defibrillator (ICD) or cardiac resynchronisation therapy (CRT) – a sophisticated and complex pacemaker device, also known as a Bi-Ventricular Pacemaker.

Besides Dilated Cardiomyopathy or DCM, here are two other relatively common forms of Cardiomyopathy which we see: Hypertrophic Cardiomyopathy, also known as Hypertrophic Obstructive Cardiomyopathy (HCM) and Arrhythmogenic Right Ventricular Cardiomyopathy – also known as Arrhythmogenic Right Ventricular Dysplasia (ARVC or ARVD).

In HCM, the heart muscle is abnormally thickened and the muscle cells disorganised. The effects can vary, from a mild and incidental finding in later years, to causing occasional and non-limiting symptoms of breathlessness, chest pain and palpitations. Sadly, HCM can cause severe problems, including the risk of sudden cardiac death (SCD) occasionally affecting the young or athletes; and some patients need protection with an implantable defibrillator (ICD).

The diagnosis of HCM is made from symptoms, family history, findings on physical examination, the ECG, echocardiogram, and sometimes cardiac MRI. Full assessment for a HCM patient may require heart rhythm monitoring and exercise treadmill testing as well, and genetic screening may be useful in some families.

ARVC is less commonly diagnosed. Again, in its most dramatic form, ARVC can sadly and tragically cause sudden cardiac death in young people or athletes. Other symptoms can include palpitation, blackout or syncope, or sometimes breathlessness and fluid retention or oedema.

ARVC can be a challenging diagnosis to make, requiring some time, as abnormalities on the ECG, echocardiogram and /or cardiac MRI can be subtle. Again, some ARVC patients need protection with an implantable defibrillator (ICD).