Treatments and drugs

By Mayo Clinic Staff

The overall goals of treatment for cardiomyopathy are to manage your signs and symptoms, prevent your condition from worsening, and reduce your risk of complications. Treatment varies by which major type of cardiomyopathy you have.

Dilated cardiomyopathy

If you're diagnosed with dilated cardiomyopathy, your doctor may recommend medications, surgically implanted devices or a combination of both. The medications you may be prescribed include:

  • Angiotensin-converting enzyme (ACE) inhibitors to improve your heart's pumping capability, such as enalapril (Vasotec), lisinopril (Zestril, Prinivil), ramipril (Altace) and captopril (Capoten).
  • Angiotensin receptor blockers (ARBs) for those who can't take ACE inhibitors, such as losartan (Cozaar) and valsartan (Diovan).
  • Beta blockers to improve heart function, such as carvedilol (Coreg) and metoprolol (Lopressor, Toprol-XL).
  • Digoxin (Lanoxin). This drug, also referred to as digitalis, tends to slow the heartbeat and help the heart pump more strongly. Digoxin may reduce heart failure symptoms and reduce the need for hospitalization for heart failure.
  • Diuretics. Often called water pills, diuretics make you urinate more frequently and keep fluid from collecting in your body. Commonly prescribed diuretics for heart failure include bumetanide (Bumex) and furosemide (Lasix). The drugs also decrease fluid in your lungs, so you can breathe more easily. One diuretic, spironolactone (Aldactone), may also be helpful in treating scarring of your heart tissue.

Another option for some people with dilated cardiomyopathy is a special pacemaker that coordinates the contractions between the left and right ventricles (biventricular pacing). In people who may be at risk of serious arrhythmias, drug therapy or an implantable cardioverter-defibrillator (ICD) may be options. An ICD is a small device — about the size of a box of matches — implanted in your chest to continuously monitor your heart rhythm and deliver electrical shocks when needed to control abnormal, rapid heartbeats. The device can also work as a pacemaker.

Hypertrophic cardiomyopathy

Your doctor may recommend beta blockers to relax your heart, slow its pumping action and stabilize its rhythm. These medications include Lopressor or calcium channel blockers, such as verapamil (Calan, Verelan, others). Medications are often the preferred treatment for hypertrophic cardiomyopathy.

If medications don't work, you may need surgery or a medical device to treat your condition. Options include:

  • Septal myectomy. This is an open-heart operation in which the surgeon removes part of the thickened, overgrown heart muscle wall (septum) that separates the two bottom heart chambers (ventricles). Removing part of this overgrown muscle improves blood flow and reduces mitral regurgitation. Myectomy is used if medications don't relieve symptoms.
  • Septal ablation. Also called septal alcohol ablation, this is a treatment in which a small portion of the thickened heart muscle is destroyed by injecting alcohol through a catheter into the artery supplying blood to it. There are possible complications with this procedure, including heart block — a disruption of the heart's electrical system — which requires implantation of a pacemaker. The long-term success of this procedure isn't yet known, but it's becoming more commonly used.
  • Implantable cardioverter-defibrillator (ICD). This is a pager-sized device implanted in your chest like a pacemaker. An ICD continuously monitors your heartbeat. If a life-threatening arrhythmia occurs, the ICD delivers precisely calibrated electrical shocks to restore a normal heart rhythm. A small number of people with hypertrophic cardiomyopathy are at risk of sudden cardiac death because of abnormal heart rhythms. In these high-risk individuals, many doctors recommend the implantation of an ICD.
  • Pacemaker implantation. A pacemaker is a small electronic device inserted under your skin that sends electrical signals to your heart to monitor and regulate your heartbeat. Pacemaker implantation is generally not as effective as surgical options, but it's sometimes used in older people who want to avoid more-invasive procedures.

Restrictive cardiomyopathy

Treatment for restrictive cardiomyopathy focuses on improving symptoms. Your doctor will recommend you pay careful attention to your salt and water intake and monitor your weight daily. Your doctor may also recommend you take diuretics if sodium and water retention becomes a problem. You may be prescribed medications to lower your blood pressure and control fast or irregular heart rhythms. If the cause of your restrictive cardiomyopathy is found, treatment will also be directed at the underlying disease, such as amyloidosis.

Many of the medications that doctors prescribe for cardiomyopathy may have side effects. Be sure to discuss these possible side effects with your doctor before taking any of these drugs.

Heart transplant and ventricular assist devices (VADs)

If you have severe cardiomyopathy and medications can't control your symptoms, a heart transplant may be an option. Because of the shortage of donor hearts, even people who are critically ill may have a long wait before having a heart transplant. In some cases, a mechanical heart assist device can help critically ill people as they wait for an appropriately matched donor. These devices — known as ventricular assist devices (VADs) or the more commonly used left ventricular assist devices (LVADs), which support the left ventricle — can help blood circulate through your heart for months or even years. A VAD may allow you to live outside the hospital while you wait. In some people who aren't candidates for a heart transplant, VAD therapy could be a long-term treatment option. Devices such as a total artificial heart also are available. The total artificial heart supports both the left and right ventricles for people waiting for heart transplants. New mechanical devices to support the heart continue to be developed and improved.

Jan. 24, 2014