Alternate Names: Cardiomyopathy - ischemic

Causes and Risks:

Ischemic cardiomyopathy is one cause of heart failure and is a complication of coronary artery disease, which in turn may cause acute MI, angina, or unstable angina. In some people there are no symptoms.

Ischemic cardiomyopathy is the most common cardiomyopathy in the US. It affects approximately 1 out of 100 people, most often middle-aged to elderly men. In older age ranges, the gender difference becomes less pronounced.

Risks include having a personal or family history of MI, angina, unstable angina, atherosclerosis, or other coronary artery diseases. Hypertension, smoking, diabetes, high fat diet, high blood cholesterol, obesity, and (rarely) stress can all precipitate ischemic heart disorders.

Prevention:

Minimize, reduce, or control risk factors wherever possible. After approval by the health care provider, exercise to improve cardiovascular fitness. Dietary modifications may be recommended in some cases.

Symptoms:

• chest pain
  • experienced under the sternum
  • may radiate to the neck, jaw, back, shoulder, arm
  • may feel tight, pressure, crushing, squeezing
  • may or may not be relieved by rest or nitroglycerin
• sensation of feeling the heart beat (palpitations)
• irregular or rapid pulse
• shortness of breath, especially with activity
• shortness of breath that occurs after lying down for a while
• cough
• fatigue, weakness, faintness
• decreased alertness or concentration
• decreased urine output
• excessive urination at night
• overall swelling
• breathing difficulty when lying down

Note: The symptoms are those of left-sided heart failure, ischemia (the main symptom being angina), or both.

Signs and Tests:

Examination may reveal an irregular heartbeat, and heart and lung sounds may be abnormal. There may be other signs of heart failure.

Decreased functioning and enlargement of the heart may show in these tests:

• Coronary angiography
• Echocardiogram
• Chest X-ray
• Chest CT scan
• MRI of chest

An ECG may show enlargement, old MI, ischemic changes, arrhythmias, or other abnormality.

A biopsy of the heart may be needed to rule out other disorders.

Lab tests may be used to rule out other disorders and to assess the condition of the heart:

• CBC
• Coronary risk profile
• Blood chemistries
• Cardiac biochemical markers (CK-MB, troponin)

Treatment:

Treatment is focused on relief of symptoms and treatment of causative disorders. Hospitalization may be required when symptoms of acute ischemic heart disease are present.

Medications include nitroglycerin and vasodilators to control cardiac pain(if present) and to relieve the workload of the heart. Other medications to stabilize the condition include digoxin, diuretics, amrinone, or others.

Devices such as the intraaortic balloon pump (IABP) may be needed for a short time to assist circulation in cases of life-threatening heart failure.

Causes of ischemia (for example, atherosclerosis or clots in the coronary artery) should be treated.

Activity is usually prescribed as bedrest until stable. Gradually, activity is increased as tolerated.

A heart transplant may be recommended.

If you smoke or drink alcohol, stop doing so, because these habits increase the workload of the heart.

Prognosis: The outcome varies. The disorder is chronic and the condition may deteriorate rapidly.

Complications:

• Arrhythmias, including lethal arrhythmias
• Cardiogenic shock

Go to the emergency room or call the local emergency number (such as 911) if symptoms indicate ischemic cardiomyopathy may be present, or if chest pain is present and not relieved by rest or nitroglycerin.