Ischemic Cardiomyopathy

Ischemic Cardiomyopathy

Heart & Vascular Health
Health & Wellness
Contributed byMaulik P. Purohit MD MPHOct 17, 2018

What are the other Names for this Condition? (Also known as/Synonyms)

  • Generalized Ischemic Myocardial Dysfunction
  • Ischemic Heart Disease 

What is Ischemic Cardiomyopathy? (Definition/Background Information)

  • Ischemic Cardiomyopathy is a heart condition, where reduced blood supply to the heart results in a weak heart that cannot pump blood effectively
  • This happens, when an individual suffers from a heart attack, or blockages occur in the blood vessels supplying the heart
  • All other organs are unable to receive enough blood supply as the heart is too weak to pump blood effectively. This condition is called as congestive heart failure
  • The signs and symptoms of Ischemic Cardiomyopathy may include shortness of breath, leg swellings, chest pressure, and difficulty lying flat on the bed, waking-up suddenly in the middle of the night with gasping spells, etc.
  • The treatment measures include drugs that help improve heart function, water pills to remove excess fluid in the body, a healthy diet and regular exercise. With proper treatment the prognosis for Ischemic Cardiomyopathy may be improved 

Who gets Ischemic Cardiomyopathy? (Age and Sex Distribution)

  • Ischemic Cardiomyopathy is usually seen in middle-aged to elderly adult males
  • Women may suffer from this condition, mostly after menopause 

What are the Risk Factors for Ischemic Cardiomyopathy? (Predisposing Factors)

The risk factors of Ischemic Cardiomyopathy include:

  • A ‘previous’ heart attack is a major risk factor for Ischemic Cardiomyopathy
  • Heart attacks at a young age in close family members also increase the risk
  • Heart attacks, below the age of 55 years in males and below 65 years in females, are considered as risks factors for Ischemic Cardiomyopathy
  • Any factor that promotes blockages in blood vessels supplying the heart can cause this heart condition
  • Sedentary lifestyles, smoking, high blood pressures, high cholesterol levels, diabetes, and obesity, are all important risk factors
  • Other medical conditions include peripheral vascular disease (blockages in the blood vessels in the legs and neck) and kidney disease

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider. 

What are the Causes of Ischemic Cardiomyopathy? (Etiology)

  • A previous heart attack or blockages in the blood vessels supplying the heart (coronary artery disease) results in weakening of the main chambers of the heart (ventricles)
  • These ventricles become weak and dilated; scars may also develop in the cardiac muscles. This causes Ischemic Cardiomyopathy
  • The heart muscle is unable to pump blood to the rest of the body sufficiently after these events and it can lead to a congestive heart failure
  • All the symptoms of Ischemic Cardiomyopathy are primarily related to congestive heart failure 

What are the Signs and Symptoms of Ischemic Cardiomyopathy?

The signs and symptoms of Ischemic Cardiomyopathy include:

  • Shortness of breath and swelling of the legs are commonly observed with Ischemic Cardiomyopathy. They usually get progressively worse, if not treated
  • Shortness of breath is initially related to physical activity and at later stages, may be present even at rest
  • Difficulty lying flat on the bed (orthopnea)
  • Gasping spells in the middle of the night (paroxysmal nocturnal dyspnea)
  • Chest pain or pressure may be present along with the above symptoms
  • Fatigue and weakness are commonly associated with cardiomyopathy
  • Dizziness and lightheadedness may also be noticed 

How is Ischemic Cardiomyopathy Diagnosed?

The diagnosis of Ischemic Cardiomyopathy could include:

  • Clinical symptoms, a comprehensive physical exam, and thorough medical history, can aid in the diagnosis of Ischemic Cardiomyopathy
  • Routine blood tests along with special tests, like lipid panels are also ordered
  • Heart function is assessed by ECG and echocardiogram
    • ECG is a trace recording of the electrical activity of the heart
    • An echocardiogram assesses the functioning of the heart
  • Stress test of the heart may be done, to determine the heart’s tolerance to physical activities
  • To assess blood flow through the vessels supplying the heart, a coronary angiogram may be undertaken. Angiogram is done by passing a catheter through the groin or wrist into the blood vessels of the heart. Contrast dye is then injected and pictures are taken
  • Imaging studies, like chest x-ray and sometimes, an MRI of the heart may also be obtained
  • Myocardial perfusion imaging scan to analyze the functioning of the heart

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis. 

What are the possible Complications of Ischemic Cardiomyopathy?

Complications of Ischemic Cardiomyopathy may include:

  • Possible complications include a risk of heart failure or a heart attack
  • Frequent hospitalizations may be needed in the later stages, if symptoms are not well controlled
  • When the heart chambers are enlarged, there is risk of formation of blood clots in the heart chambers. These blood clots may get dislodged, resulting in a stroke
  • Dilated heart chambers also increase the risk for abnormal heart rhythms

Severe cardiomyopathy and abnormal heart rhythms pose a risk for sudden death. 

How is Ischemic Cardiomyopathy Treated?

The treatment of Ischemic Cardiomyopathy is directed towards improving heart function and removal of the volume overload that builds up in the body, as the heart fatigues in pumping it out.

  • Drugs that help improve the heart’s function are known as ACE inhibitors (angiotensin converting enzyme inhibitors). They help in remodeling of the heart muscle and improve heart function
  • Drugs, like beta blockers (Metoprolol Succinate, Bisoprolol, and Carvedilol) also help in improving the functioning of the heart
  • Digoxin is a kind of drug that squeezes the heart to improve pumping and relieve the symptoms. It also reduces the frequency of hospitalization and length of stay in the hospital
  • Diuretics or water pills play a major role in removing excess fluid from the body
  • Blood pressure medications, like hydralazine and nitrates, are also used in the treatment
  • Blood thinners, like warfarin, may be used if there are blood clots in the heart, or if there are abnormal heart rhythms
  • Cholesterol control and diabetes control is important for coronary artery disease
  • A balloon angioplasty or stent placement in the heart may be required to open up the clogged blood vessels of the heart
  • An open heart bypass surgery may be required in certain cases of Ischemic Cardiomyopathy.
  • Automated implantable cardioverter defibrillator (AICD) may be indicated in a few individuals, when the heart pumping (ejection fraction) is very low
  • Pacemaker may be needed, if there are abnormal heart rhythms 

How can Ischemic Cardiomyopathy be Prevented?

A few preventive measures for Ischemic Cardiomyopathy include:

  • A low salt diet is important to control blood pressure and many other heart-related conditions
  • A diet high in fiber that can be found in most vegetables and fruits is generally recommended
  • Avoiding fatty foods that are high in cholesterol and low in saturated fats is beneficial
  • Exercising adequately is a healthy choice with long-term benefits 

What is the Prognosis of Ischemic Cardiomyopathy? (Outcomes/Resolutions)

  • With proper treatment, individuals with Ischemic Cardiomyopathy may have an improved prognosis
  • If left untreated, this disease can cause serious complications, such as heart failure, stroke, and ultimately lead to death 

Additional and Relevant Useful Information for Ischemic Cardiomyopathy:

The following DoveMed website link is a useful resource for additional information:

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Maulik P. Purohit MD MPH

Assistant Medical Director, Medical Editorial Board, DoveMed Team


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