Heart Failure / Cardiomyopathies

The diagnosis of heart failure indicates that the heart is not functioning normally. It is a broad term that includes any reduction in heart function, be it mild, moderate or severe. Cardiomyopathy is the medical term for any disease of the heart muscle and can be a cause of heart failure. 

Conditions that can lead to heart failure include:

  • Coronary artery disease, usually as a consequence of a previous heart attack
  • Hypertension
  • Cardiomyopathy
  • Arrhythmias, most commonly atrial fibrillation
  • Heart valve problems
  • Congenital heart disease – birth defects that affect the normal workings of the heart
  • Chronic excess alcohol consumption

A cardiomyopathy can be acquired or inherited. The commonest acquired cause is a viral infection that causes inflammation of the heart muscle (myocarditis). Some medical conditions (eg sarcoid, lupus) can cause a cardiomyopathy. In many cases, the cause is unknown.

The common inherited conditions are:

  • Dilated cardiomyopathy
  • Hypertrophic cardiomyopathy
  • Arrhythmogenic right ventricular cardiomyopathy

You may be advised to be screened if a family member has one of these conditions.

Investigations

  • The diagnosis is usually made with echocardiography
  • There is a blood test (BNP) that, if normal, usually rules out the diagnosis
  • Depending on the suspected cause, a Cardiac MRI may be recommended

Management

The empirical management of heart failure is with medications to help the function of the heart and reduce the risk of fluid overload. Classes of drugs include:

  • ACE Inhibitors/ Angiotensin Receptor Blockers
  • Beta-blockers
  • Diuretics
  • Spironolactone 

Depending on the underlying cause, the appearance of the resting ECG and/ or the severity of heart failure, there may be a recommendation to have a specialised pacemaker (Cardiac Resynchronisation Therapy) which can improve symptoms in some patients.

If a patient with heart failure and/ or a cardiomyopathy is thought to be at high risk of a life-threatening arrhythmia, there may be a recommendation to have an Implantable Cardiac Defibrillator (ICD).