| | | | Other Names | | | Hypertrophic Cardiomyopathy, Ischemic Cardiomyopathy, Disorders of the
Myocardium, Myocardium.
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| | | Cardiomyopathy refers to abnormalities in the structure or function of the
heart muscle. There are three major types of cardiomyopathy: dilated
congestive, hypertrophic, and restrictive. The most prevalent form is
dilated congestive cardiomyopathy (DCM). In people with DCM, the heart
muscle is damaged, most commonly by coronary artery disease
(atherosclerosis).1 People with diabetes have been reported to be at
increased risk of DCM.2 DCM can also be triggered by alcohol abuse,
infections, exposure to certain drugs and toxins, nutritional
deficiencies, connective tissue diseases, hereditary disorders, and
pregnancy.
In DCM, the heart gradually loses its efficiency as a
pump. Cardiomyopathy is a serious health condition and requires expert
medical care rather than self-treatment. However, because of the
associations between cardiomyopathy and diseases such as atherosclerosis,
diabetes, hypertension, and congestive heart failure, lifestyle
recommendations for the prevention of these conditions may also help
prevent DCM.
Hypertrophic cardiomyopathy is usually a hereditary
disorder, although incidence of this form of cardiomyopathy may also be
higher in people with hypertension.3 Restrictive cardiomyopathy is usually
due to a connective tissue disease, cancer, or an autoimmune condition.
Both hypertrophic and restrictive cardiomyopathies are relatively
uncommon.
What are the symptoms of cardiomyopathy? People with
cardiomyopathy may have difficulty breathing during light exertion, and
they may become fatigued easily. Other chronic symptoms are swelling
around the ankles and an enlarged abdomen.
Conventional treatment
options: The conventional treatment includes specific therapy for any
underlying cause and may also include ACE inhibitors (e.g., captopril,
enalapril, lisinopril), beta-blockers, the combination of hydralazine and
isosorbide dinitrate, digitalis, and diuretics. In some cases, heart
transplantation surgery may be recommended.
Dietary changes that
may be helpful: Protein-calorie malnutrition (PCM) may cause
cardiomyopathy, though PCM is rare in U.S. society.
Lifestyle
changes that may be helpful: Cardiomyopathy occurs with greater frequency
in people who drink to excess.4 Alcoholics are at significantly greater
risk of developing a deficiency of thiamine (vitamin B1).5 6 They also may
develop a form of thiamine deficiency called wet beri beri or Shoshin beri
beri, which frequently includes cardiomyopathy.7 8 See "Nutritional
supplements that may be helpful," below, for more
information.
Among alcoholics, the risk of developing DCM is
greater for women than for men.9 Many doctors suggest that people with
cardiomyopathy abstain from alcohol consumption. People with
alcohol-induced cardiomyopathy who avoid alcohol may regain their
health.
Moderate to heavy physical activity can be life-threatening
for people with cardiomyopathy;10 however, appropriate exercise often
improves the condition.11 12 13 14 How much is "too much" varies from
person to person. Any exercise program undertaken by someone with
cardiomyopathy requires professional supervision.
The risk of being
diagnosed with cardiomyopathy goes up with the number of cigarettes smoked
per day.15 16 However, a few studies have reported a paradoxical decrease
in the death rate among smokers with DCM compared with nonsmokers who have
this disease.17 18 While the meaning of this association remains unclear,
virtually all doctors recommend that smokers with DCM quit smoking for a
wide variety of health-related reasons.
Nutritional supplements
that may be helpful: People with DCM have been shown to be deficient in
coenzyme Q10.19 Most studies using coenzyme Q10 in the treatment of
cardiomyopathy have demonstrated positive results, including improved
quality of life, heart function tests, and survival rates.20 21 22
Coenzyme Q10 also has been shown to improve cardiac function in people
with hypertrophic cardiomyopathy-a less common form of cardiomyopathy.23 A
few studies, however, have found no benefit from CoQ10 supplementation in
treating people with cardiomyopathy.24 25 Despite a lack of consistency in
the outcomes of published research, many doctors recommend that 100 to 150
mg be taken each day, with meals.
Deficiency of L-carnitine, an
amino acid, is associated with the development of some forms of
cardiomyopathy.26 Inherited forms of cardiomyopathy seen in children may
be the most responsive to therapy with L-carnitine.27 28 Whether carnitine
supplementation helps the average person with cardiomyopathy remains
unknown. Nonetheless, some doctors recommend 1 to 3 grams of carnitine per
day for adults of average weight.
Several veterinary studies have
demonstrated benefits from supplementation with taurine, another amino
acid, in animals with cardiomyopathy. Most of these studies showed taurine
deficiency to be a cause of cardiomyopathy. Taurine supplementation in
animals with DCM has resulted in improvement of symptoms and survival
rates.29 30 However, clinical studies in humans are lacking; thus, despite
a good safety record, the benefits of taurine supplementation in people
with any form of cardiomyopathy remain speculative. When taurine
supplements are used by doctors to treat people with other conditions, 2
grams taken three times per day for a total of 6 grams per day is often
recommended.
Selenium deficiency has occasionally been reported as
a cause of cardiomyopathy.31 32 Selenium deficiency is the probable cause
of Keshan's disease, a form of cardiomyopathy found in China33 34 but only
rarely reported in the United States.35 Studies comparing populations in
parts of the world other than mainland China have not supported a link
between selenium deficiency and DCM,36 37 except in Taiwan.38 Moreover, no
clinical trials outside of China have explored the effects of
supplementation with selenium for people with DCM, nor is there reason to
believe that selenium supplementation would help most people outside of
China and Taiwan suffering from cardiomyopathy.
The small
proportion of people with cardiomyopathy whose disease is due to severe
vitamin B1 (thiamine) deficiency (known as wet beri beri) generally
require intravenous vitamin B1, followed by oral supplementation. Vitamin
B1 does not appear to be helpful for other types of cardiomyopathy. People
requiring vitamin B1 for cardiomyopathy must first be diagnosed as having
wet beri beri, and treatment must be supervised by a healthcare
professional.
Are there any side effects or interactions? Refer to
the individual supplement for information about any side effects or
interactions.
Herbs that may be helpful: Many doctors expert in
herbal medicine consider hawthorn to be an effective and low-risk therapy
for congestive heart failure, the main complication of cardiomyopathy.
Rigorous clinical trials have now confirmed the effectiveness of hawthorn
for the signs and symptoms of early-stage congestive heart failure,39 40
41 though hawthorn studies with cardiomyopathy patients have yet to be
conducted. The clinical trials with heart-failure patients have
demonstrated efficacy using 80 to 300 mg of standardized extract of
hawthorn leaves and flowers two to three times per day.
Two herbs
used in the traditional medicine of India (Ayurveda) to treat people with
cardiomyopathy and congestive heart failure have recently been supported
by a small amount of clinical research. Arjun (Terminalia arjuna) has been
shown to significantly improve the signs and symptoms of cardiomyopathy,
as well as the objective measurements of heart function.42 In a clinical
trial, people with DCM and severe heart failure took 500 mg of arjun
extract three times daily. After two weeks, significant improvement in
heart function was observed, an effect that continued over the course of
approximately two years.43 The arjun used in this study was concentrated,
but not standardized for any particular constituent. Commercial
preparations are sometimes standardized to contain 1% arjunolic
acid.
Another Ayurvedic herb, coleus, contains forskolin, a
substance that may help dilate blood vessels and improve the forcefulness
with which the heart pumps blood.44 Recent clinical studies indicate that
forskolin improves heart function in people with cardiomyopathy and
congestive heart failure.45 46 A preliminary trial found that forskolin
reduced blood pressure and improved heart function in people with
cardiomyopathy. These trials used intravenous injections of isolated
forskolin. It is unknown whether oral coleus extracts would have the same
effect. While many doctors and practitioners of herbal medicine would
recommend 200 to 600 mg per day of a coleus extract containing 10%
forskolin, these amounts are extrapolations and have yet to be confirmed
by direct clinical research.
Dan shen (Salvia miltiorrhiza), a
Chinese herb, has been traditionally used to treat angina and coronary
artery disease. Some studies suggest that dan shen may improve the force
of heart contractions and coronary circulation, and may prevent damage to
the heart muscle that might lead to cardiomyopathy.47 48 49 However, no
clinical trials of dan shen for DCM have been reported. Doctors expert in
Chinese herbal medicine typically recommend 1 to 6 grams per day of dried
root.
Are there any side effects or interactions? Refer to the
individual herb for information about any side effects or
interactions.
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Please Note: This Traditional Use information is provided as a courtesy only. The products indicated above may be listed in error. This information is based on Traditional and Folklore Medicine which uses natural materials to support health. This information has not been evaluated or approved by the FDA and is not based on scientific evidence from any source. These statements have not been evaluated by the Food and Drug Administration (FDA). These products are intended to support general well being and are not intended to treat, diagnose, mitigate, prevent, or cure any condition or disease. If conditions persist, please seek advice from your medical doctor.
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