Ischemic Cardiomyopathy
Definition
Ischemic cardiomyopathy is a term used to describe patients whose heart can no longer pump enough blood to the rest of their body due to coronary artery disease.
Coronary artery disease is a narrowing of the small blood vessels that supply blood and oxygen to the heart.
These patients often haveheart failure.
Alternative Names
Ischemic heart disease; Cardiomyopathy - ischemic
Causes, incidence, and risk factors
Ischemic cardiomyopathy is caused by coronary heart disease -- the buildup of a hard substance called plaque in the arteries to the heart. This may also be called hardening of the arteries.
When the arteries that bring blood and oxygen to the heart are blocked or very narrowed, over time, the heart muscle does not work as well. It becomes harder for the heart to fill and pump blood to the body. Patients with this condition usually have a history of heart attacks or angina (chest pain).
Ischemic cardiomyopathy is a common cause of heart failure. It is the most common type of cardiomyopathy in the United States. It most often affects middle-aged and elderly people.
For risk factors, see: Coronary heart disease
References
Morrow DA, Boden WE. Stable ischemic heart disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa; Saunders Elsevier;2011:chap 57.
Review Date: 5/23/2011
Reviewed By: Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
Ischemic heart disease; Cardiomyopathy - ischemic
Symptoms
Patients with this condition often have had symptoms of angina or a heart attack. Sometimes, patients do not notice any symptoms.
Symptoms of heart failure usually develop slowly over time. Common symptoms include:
- Cough
- Fatigue, weakness, faintness
- Irregular or fast pulse, or a sensation of feeling the heart beat (palpitations)
- Loss of appetite
- Shortness of breath, especially with activity
- Shortness of breath that occurs after lying down
- Swelling of feet and ankles (in adults)
- Swelling of the abdomen (in adults)
- Waking up from sleep after a couple of hours due to shortness of breath
Signs and tests
The physical exam may be normal, or there may be signs that fluid is building up in the body:
There may be other signs of heart failure.
This condition is usually diagnosed if a test shows that the heart is not pumping as well as it should. This is called a decreased ejection fraction. A normal ejection fraction is around 55 - 65%. Many patients with this disorder have ejection fractions much less than this.
People with ischemic heart disease can have the symptoms and signs of ischemic cardiomyopathy even when their ejection fraction is normal or near normal. This is because the heart does not fully relax (impaired filling). It is sometimes called "diastolic heart failure" or "heart failure with preserved ejection fraction."
Tests used to measure ejection fraction include:
- Gated SPECT
- MRI of heart
- Ventriculogram or cardiac blood pooling imaging
Biopsy of the heart is needed in rare cases to rule out other conditions.
References
Morrow DA, Boden WE. Stable ischemic heart disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa; Saunders Elsevier;2011:chap 57.
Review Date: 5/23/2011
Reviewed By: Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
Ischemic heart disease; Cardiomyopathy - ischemic
Treatment
To treat ischemic cardiomyopathy, your doctor will treat and manage your heart failure by:
Showing you how to make important changes in your lifestyle
Teaching you about the symptoms of heart failure
Giving you medicines for heart failure
Giving you a
pacemaker to help treat a slow heart rate or help the heart beat in a more normal way
Implanting a defibrilator, which recognizes abnormal heart rhythms and sends an electrical pulse to stop them
See also: Heart failure
A cardiac catheterization might be done to see if you need coronary artery bypass (CABG) surgery or a balloon procedure (angioplasty). These procedures can improve blood flow to the damaged or weakened heart muscle.
You may need a heart transplant if you have tried all the standard treatments and still have very severe symptoms. Implantable, artificial heart pumps are now available. However, very few patients are able to have these advanced treatments.
Expectations (prognosis)
Often, heart failure can be controlled with medicine, lifestyle changes, and by treating the disease that caused it.
Heart failure may suddenly become worse due to angina, heart attack, infections, other illnesses, eating foods that high in salt, and not taking medicines correctly.
Heart failure is usually a long-term (chronic) illness. It may get worse over time.
Some people develop severe heart failure. Medicines, surgery, and other treatments no longer help. They are at risk for dangerous heart rhythm problems.
Calling your health care provider
Go to the emergency room or call 911 if:
References
Morrow DA, Boden WE. Stable ischemic heart disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa; Saunders Elsevier;2011:chap 57.
Review Date: 5/23/2011
Reviewed By: Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
Ischemic heart disease; Cardiomyopathy - ischemic
Prevention
Some of the risks for heart disease that you CAN change are:
Do not smoke or use tobacco.
Get plenty of exercise -- at least 30 minutes a day, at least 5 days a week (talk to your doctor first)
Stay at a healthy weight. Try for a body mass index (BMI) of between 18.5 and 24.9.
Get checked and treated for depression.
Women at high risk for heart disease should take omega-3 fatty acid supplements.
If you drink alcohol, limit yourself to no more than one drink a day for women, and no more than two drinks a day for men. Because alcohol in large amounts can be toxic to the heart, you may be asked to limit your alcohol even more, or stop drinking it completely.
Good nutrition is important for your heart health and will control some of your risk factors. See also: Heart disease and diet
References
Morrow DA, Boden WE. Stable ischemic heart disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa; Saunders Elsevier;2011:chap 57.
Review Date: 5/23/2011
Reviewed By: Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Review Date: 5/23/2011
Reviewed By: Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.