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Cardiomyopathy Treatment
If you have cardiomyopathy but don't have , you may not need treatment. Some types that occur suddenly, such as dilated cardiomyopathy or takotsubo cardiomyopathy, may go away on their own.
If your healthcare provider recommends treatment, your treatment plan will depend on the type of cardiomyopathy you have, how serious it is, and whether you have any complications. Talk with your provider about your needs and goals so the treatment plan will work for you.
Treatment for cardiomyopathy might not cure the problem with your heart. The main goals of treatment are to:
- Control your symptoms so that you can have a good quality of life
- Manage any medical conditions that caused cardiomyopathy
- Prevent serious problems, such as cardiac arrest or cardiogenic shock
- Stop cardiomyopathy from getting worse
Your treatment may include medicines, procedures, and devices. Patients with cardiomyopathy or heart failure should see a cardiologist consultation to help manage their disease. A cardiologist is a doctor who specializes in diagnosing and treating heart disease.
Be sure to let your provider know if you're planning a pregnancy, if you are pregnant, or if you're breastfeeding. Not all medicines and procedures are safe for people who are pregnant or feeding breastmilk to a baby.
Medicines
The following medicines can help treat symptoms of different types of cardiomyopathies.
- Medicines to remove extra and fluid from your body: These include diuretics and aldosterone antagonists. These medicines lower the amount of blood that the heart must pump. Very high doses of diuretics may cause low , , and worsening heart failure symptoms. Side effects of aldosterone antagonists can include kidney disease and high potassium levels.
- Medicines to relax your blood vessels and help your heart pump blood: These include angiotensin-converting inhibitors, angiotensin II blockers, and combination hydralazine/isosorbide dinitrate, which is used to treat heart failure in Black people. An angiotensin receptor neprilysin inhibitor may be used to treat people who have developed heart failure. To treat heart failure with an ejection fraction less than 45%, providers may prescribe vericiguat to reduce hospitalizations and improve survival. Possible side effects include headaches, cough, low blood pressure, and kidney disease.
- Medicines to slow your heart rate: Providers may prescribe beta blockers, calcium channel blockers, or ivabradine to help correct a heartbeat that's too fast or is irregular (arrhythmia). They make it easier for your heart to pump blood. Possible side effects include a slow or irregular heart rate, high blood pressure, and vision problems. These medicines can also make some arrhythmias worse.
- Medicines to balance your levels: These can help your heart work better. Side effects include kidney disease and high potassium levels in your blood.
- Blood thinners (anticoagulants): These medicines help prevent . However, they can raise your risk of serious bleeding.
- Digoxin: This is used to treat a fast or irregular heartbeat. Digoxin can cause nausea, vomiting, and diarrhea. It may also cause some types of arrhythmias.
- Sodium-glucose cotransporter-2 (SGLT-2) inhibitors: These medicines are often used to treat diabetes but can also help your heart work better. Possible side effects include kidney disease and infections.
- Medicine to relax the heart muscle: If you have obstructive hypertrophic cardiomyopathy, your provider may prescribe a type of medicine called mavacamten. It can improve your quality of life and reduce symptoms. Mavacamten may raise the risk of heart failure, so only people who have an ejection fraction of at least 55% are eligible for this treatment.
- Complementary and alternative treatments: Studies show that some dietary supplements and foods can reduce symptoms of cardiomyopathy and heart failure. Talk with your provider about the possible benefits of nutritional supplements, vitamins, and minerals. Be sure to discuss any nutritional supplements you're already taking. Some may interfere with other treatments or cause side effects.
Procedures and implanted devices
Talk with your provider about a procedure or device if medicines don't help improve your symptoms.
Alcohol septal ablation
Septal shrinks the septum (the muscle dividing the left and right lower chambers of the heart). This may help your heart work better. It is used only to treat hypertrophic cardiomyopathy.
Learn what the heart looks like.
Septal myectomy
If you have hypertrophic cardiomyopathy and your symptoms are serious, your provider may remove part of the thickened septum. This heart surgery may help your heart work better. You will be asleep during the procedure. NHLBI scientists are developing ways to remove part of the thickened septum using cardiac catheterization instead of surgery.
Catheter ablation
Catheter ablation is a procedure to stop faulty electrical signals from moving through your heart and causing an irregular heartbeat.
Ablation is done with cardiac catheterization. Your provider will pass flexible tubes, or catheters, through your blood vessels until they reach your heart. The catheters can locate the source of your abnormal heartbeats. Other catheters can deliver treatments. Your provider will aim the tip of a special catheter at the small area of heart tissue. A machine will use energy or extremely cold temperatures to create a scar on the heart. The scar prevents abnormal electrical signals from causing an irregular heartbeat.
Catheter ablation has some risks both during the procedure and during recovery, including bleeding, infection, and damage to the heart or blood vessels.
Medical devices
Cardiomyopathy increases the risk of life-threatening events such as cardiac arrest or cardiogenic shock. If you have complications, such as an arrhythmia or heart failure, you may need a surgically implanted device, such as a left ventricular assist device, an implanted cardioverter defibrillator (ICD), or a pacemaker to help keep you safe.
Another type of implantable device allows providers to remotely check heart function in people who have worsening symptoms linked with heart failure. Your provider will insert the monitoring device in a blood vessel using cardiac catheterization. The implanted monitor can help improve quality of life by reducing hospitalizations.
If you're waiting for surgery for a heart transplant or to implant an ICD, your provider may recommend a wearable cardioverter vest. Some people may use a vest for a while if they have a type of cardiomyopathy, such as peripartum cardiomyopathy, that is likely to get better.
Heart transplant
You may need a heart transplant if you have life-threatening symptoms or complications of cardiomyopathy, and no other treatments have worked for you.
A transplant may improve your quality of life and prolong your lifespan. Your transplant team removes your diseased heart and replaces it with a healthy heart from a deceased donor.
After the surgery, you will recover in the hospital's intensive care unit and stay in the hospital for up to 3 weeks. During your recovery, you may start a cardiac rehabilitation program.
Heart transplant has some serious risks. Your provider will closely watch your health after the transplant. You'll need to take medicines for the rest of your life. Despite the risks, heart transplant has a good success rate. About 90% of patients who received heart transplants in 2020 were still alive a year later.