Treatment

• Dilated Cardiomyopathy
• Hypertrophic Cardiomyopathy
• Restrictive Cardiomyopathy (“Infiltrative”)
• Arrhythmogenic Right Ventriclular Cardiomyopathy (ARVC)

Dilated cardiomyopathy

There may be no treatment if the patient has no symptoms and/or is undiagnosed.

The treatment given involves assessing the symptoms that the cardiomyopathy gives rise to.

If there is consequent heart failure the patient is likely to be treated with:

• Diuretics,
• ACE inhibitors,
• Betablockers,
• Digoxin.

If there is consequent disturbance in heart rhythm the treatment would be likely to be:

• Antiarrhythmic medication,
• Cardioversion,
• Ablation of abnormal foci of electrical activity in the heart,
• Pacemaker,
• Implantable cardioverter defibrillator (ICD).

Not all people with dilated cardiomyopathy necessarily have symptoms and they may only show up as an incidental finding in screening such as family screening and immigration screening.

Anticoagulants are normally only used if the person has atrial fibrillation or if they have had a previous stroke.

Hypertrophic Cardiomyopathy

The effects of the disease vary widely form person to person.

• Some individuals will be on no treatment,
• Betablockers and calcium antagonists such as verapamil reduce the forceful contraction of the heart and slow the heart rate allowing it to fill better and allowing blood to flow out of the heart more easily. Dysopyramide can also be used,
• Digoxin must not be used as it may increase the obstruction to outflow,
• Arrhythmias may be treated with amiodarone and an implantable defibrillator,
• The use of a pacemaker (dual-chamber) may be necessary, especially if the patient is elderly or suffers from dangerous syncopal episodes (due to obstruction to the outflow),
• Intervention to remove some of the thickened heart muscle may be used, (i.e. open heart surgery or by catheter), when symptoms are incapacitating. This procedure is known as Septal Ablation,
• Before a dental or surgical procedure, antibiotics should be given to reduce the risk of infection of the heart valves.

Restrictive Cardiomyopathy ("Infiltrative")

• Treatment is symptomatic,
• However, treatment may not be very helpful as the medications may worsen symptoms (for instance diuretics to treat heart failure),
• Treatment of the underlying disorder (e.g. steroids for sarcoidosis),
• Treatment to prevent thrombo-embolism,
• Treatment for rhythm disturbance may be given, depending on the individual, (including pacemaker or implantable cardioverter defibrillator).

Arrhythmogenic Right Ventriclular Cardiomyopathy (ARVC)

Drug Treatment:

• ACE inhibitors,
• Anti-arrhythmic medication - such as Sotalol, Amioderone, Digoxin,
• Diuretics,
• Anticoagulation to prevent clot formation and emboli.

Other Treatment:

• Electrical cardioversion,
• Ablation of abnormal foci following Electrophysiological Studies (EPS),
• Pacemakers - for fast or slow arrhythmias,
• Implantable Cardioverter Defibrillator (ICD), which senses a dangerous abnormal rhythm in the heart and delivers a shock to get it back into normal rhythm.

All of these treatments are for arrhythmias.