Causes

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

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

Exams and Tests

The physical exam may be normal, or there may be signs that fluid is building up in the body:

• "Crackles" in the lungs (heard with a stethoscope)
• Enlarged liver
• Extra heart sounds
• Leg swelling
• Raised pressure in the neck vein

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:

• Echocardiogram
• 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.

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.

Outlook (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.

When to Contact a Medical Professional

Go to the emergency room or call 911 if:

• You have symptoms of ischemic cardiomyopathy
• You have chest pain that is not relieved by rest or nitroglycerin
• You pass out (syncope)

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

Alternative Names

Ischemic heart disease; Cardiomyopathy - ischemic

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.

Update Date: 5/23/2012

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.