Cardiomyopathy V: Interprofessional Care

Cardiomyopathy management requires adopting a low-salt diet to reduce fluid retention and prevent further cardiac damage. Patients should follow a personalized exercise and rest plan to maintain fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent exacerbating symptoms and additional heart muscle damage.

Common pharmacological treatments include ACE inhibitors like lisinopril and beta-blockers like metoprolol to reduce afterload and control neurohormonal activity. Diuretics like furosemide reduce preload and alleviate symptoms, while aldosterone antagonists help manage heart failure. Anticoagulants prevent blood clots, and antiarrhythmics treat dysrhythmias when present.

Septal myectomy is an open-heart surgical procedure for severe hypertrophic cardiomyopathy that removes a portion of the thickened septal wall obstructing blood flow. This surgery reduces symptoms and improves exercise capacity. It is the standard surgical intervention when medical management is ineffective for hypertrophic obstructive cardiomyopathy.

Alcohol septal ablation is a less invasive alternative to septal myectomy for hypertrophic cardiomyopathy patients unsuited for open-heart surgery. It involves injecting alcohol into a coronary artery to induce controlled infarction and septal thinning. However, it may have higher recurrence rates compared to septal myectomy.

Dilated cardiomyopathy management includes mitral valve repair or replacement to address secondary mitral regurgitation. For end-stage heart failure, left ventricular assist device implantation serves as a bridge to transplantation or long-term therapy. Cardiac transplantation is recommended for patients unresponsive to other treatments.

An implantable cardioverter-defibrillator (ICD) monitors and corrects life-threatening arrhythmias in cardiomyopathy patients. It significantly reduces the risk of sudden cardiac death and improves overall survival. ICDs are particularly valuable for patients at high risk of dangerous heart rhythm disturbances and provide continuous cardiac protection.

Cardiac resynchronization therapy (CRT), also called biventricular pacing, benefits patients with dilated cardiomyopathy by coordinating heart contractions. This therapy increases ejection fraction and can reverse some structural changes in the myocardium. It improves cardiac function and reduces heart failure symptoms in appropriately selected patients.