Ischemic Cardiomyopathy: Symptoms, Causes, and Treatment
What is ischemic cardiomyopathy?
Ischemic cardiomyopathy (IC) is a condition when your heart muscle is weakened as a result of a heart attack or coronary artery disease.
In coronary artery disease, the arteries that supply blood to your heart muscle become narrowed. This can keep necessary blood from reaching portions of your heart muscle, causing damage. If you develop IC, the left ventricle in your heart will likely become enlarged, dilated, and weakened. This inhibits your heart’s ability to properly pump blood, which can lead to heart failure.
Your doctor’s prescribed treatment plan will take into account how much damage your heart has sustained while aiming to treat the underlying cause of your IC, to prevent further disease progression, to help improve your cardiovascular function, and to treat any associated symptoms. A combination of lifestyle changes, medications, surgery, or other procedures may be recommended. Healthy lifestyle choices can help lower your risk of complications and reduce your chances of developing IC in the first place.
What are the symptoms of ischemic cardiomyopathy?
It’s possible to have early-stage heart disease with no symptoms. If blood flow becomes impaired due to coronary artery disease, you may experience:
- extreme fatigue
- shortness of breath
- dizziness, lightheadedness, or fainting
- chest pain and pressure, known as angina
- heart palpitations
- swelling in your legs and feet, known as edema
- swelling in your abdomen
- cough or congestion, caused by fluid in your lungs
- difficulty sleeping
- weight gain
If you develop these symptoms, seek medical care immediately.
What causes ischemic cardiomyopathy?
IC is typically caused by a heart attack or coronary artery disease. Risk factors for these conditions include:
- family history of coronary heart disease
- high blood pressure, also known as hypertension
- high cholesterol
- diabetes mellitus
- end-stage kidney disease
- amyloidosis, a condition in which abnormal proteins build up in your tissues and organs, including blood vessels
- sedentary lifestyle
- history of smoking tobacco
- alcohol or drug abuse
You’re more likely to develop coronary artery disease if you’re a man, but after women reach menopause, the gap between the two genders tends to close. If you’re a woman over the age of 35 who takes oral contraceptives and smokes tobacco, you’re also at higher risk.
How is ischemic cardiomyopathy diagnosed?
If your doctor suspects you have IC, expect to be referred to a heart specialist, also known as a cardiologist. They will take your medical history and perform a physical examination, and they likely will order further tests to develop their diagnosis.
For example, they may order:
- blood tests to measure the level of cholesterols and triglycerides in your blood
- imaging tests, such as an X-ray, CT scan, or MRI
- an echocardiogram to evaluate your heart anatomy and function using ultrasound waves
- an electrocardiogram (ECG or EKG) to record electrical activity in your heart
- a stress test to monitor your heart’s ability when it’s made to work harder
- cardiac catheterization, in which a coronary angiogram is done to check for narrowing inside your arteries
- myocardial biopsy to collect and analyze a small tissue sample from your heart muscle
How is ischemic cardiomyopathy treated?
Your doctor must first address the underlying cause of your IC in order to treat it. Most often the culprit is coronary artery disease. Doctors may recommend a combination of:
- lifestyle changes
- surgery or other procedures
To help treat coronary artery disease and lower your risk of complications, eat a healthy diet that’s low in saturated fat, cholesterol, and sodium. You’ll also be advised to exercise in a way that is safe for your condition.
If you smoke your doctor will probably advise you to quit. Avoiding drugs and drinking less alcohol is also likely in order.
Don’t approach these lifestyle changes as short-term fixes. Rather, commit to developing long-term healthy habits.
Your doctor may prescribe medications to help ease symptoms, prevent complications, and improve your heart function. Depending on your circumstances, they may prescribe:
- a beta-blocker to reduce your blood pressure and heart rate
- a calcium channel blocker to relax and widen your arteries and lower your blood pressure
- an aldosterone inhibitor to lower your blood pressure and rid your body of excess fluid to help ease symptoms such as swelling and shortness of breath
- other types of diuretics to rid your body of excess fluid, lower your blood pressure, and reduce the amount of work your heart muscle has to do
- other medication therapy to control your heart rate and rhythm
- a blood thinner
- a medication to treat high cholesterol
Surgery and other procedures
Your doctor may also recommend surgery or other procedures involving your coronary arteries or other parts of your heart. For example, they may recommend:
- implantation of a pacemaker, defibrillator, or both to improve your heart’s electrical function
- atherectomy to remove plaque from your arteries
- balloon angioplasty to help improve blood flow in narrowed arteries
- insertion of a stent, a device designed to hold arteries open
- radiation therapy after the lumen in a prior placed arterial stent repeatedly narrows, to try to keep your artery lumen from narrowing again
In very serious cases, your doctor may recommend a coronary artery bypass graft (CABG). During this open chest surgery, your surgeon will remove a portion of a healthy blood vessel from another part of your body and reattach it to your heart to restore arterial blood supply. This allows blood to bypass the segment of blocked artery, flowing through the new blood vessel and connecting to the coronary artery downstream from the segment of blockage.
If the damage to your heart is too great to repair, you may need a heart transplant.
What is the outlook for ischemic cardiomyopathy?
If left untreated, IC can lead to blood clots, heart failure, and even death. It’s critical to treat the underlying cause of your IC to prevent complications.
Your long-term outlook will depend on several factors, including:
- how much damage your heart has sustained
- the effectiveness of your treatment
- your lifestyle choices
You’re more likely to develop complications if you:
- make high-risk lifestyle choices, such as smoking tobacco or misusing alcohol
- fail to take your medications properly
- don’t seek appropriate follow-up care
- develop an infection
- have other major health conditions
Ask your doctor for more information about your condition, treatment plan, and outlook.
Can ischemic cardiomyopathy be prevented?
You can decrease your chances of developing heart disease in the first place by making smart lifestyle choices. For example:
- Monitor your blood pressure and cholesterol levels.
- Eat a healthy diet that’s low in saturated fat, cholesterol, and sodium.
- Exercise at least 30 minutes of aerobic exercise five times a week.
- Maintain a healthy weight.
- Don’t smoke tobacco or abuse drugs.
By practicing heart-healthy habits, you can lower your risk of developing coronary artery disease, ischemic cardiomyopathy, and other cardiovascular conditions. If you’ve already developed heart disease, healthy lifestyle choices can help mitigate complications.
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