Cardiomyopathy is scary. But today’s heart disease is less deadly.


Heart disease remains the leading killer in America. But medical innovations have made cardiomyopathy, also known as the dreaded condition “heart failure,” less of a threat.

Cardiomyopathy affects millions of Americans and is the leading cause of hospitalization for those over 65 years of age in the United States. When Pennsylvania Governor John Fetterman (D) suffered a stroke during his campaign for the US Senate in May, his campaign revealed that he had been diagnosed with cardiomyopathy.

Cardiomyopathy results from weakening of the heart muscle, resulting in a weak heartbeat. When the heart loses its strength, it often enlarges to compensate for the lack of pressure. Doctors often classify contractions by the “ejection fraction” – the percentage of blood that the heart can push forward. An increasing number of Americans also have heart failure with a normal ejection fraction.

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Fetterman, 52, is a case study of what can happen if appropriate treatment is not provided or followed. He was diagnosed with “atrial fibrillation, an irregular heartbeat, along with a low heart pump” in 2017 – not an uncommon initial symptom of cardiomyopathy – and was given a treatment plan that included lifestyle changes, such as restricting salt intake, losing weight and exercising Exercise, and medication that studies show can make a big difference.

But Fetterman failed to follow his doctor’s treatment plan – and didn’t even return to his cardiologist for regular consultations. After the stroke, doctors revealed his diagnosis of cardiomyopathy and implanted a pacemaker to prevent the fatal heartbeat.

As Fetterman said after his stroke: “Like many others, and many men in particular, I avoided going to the doctor, even though I knew I was not feeling well. As a result, I almost died.”

I specialize in heart failure. Patients like Fetterman are why the conversation between doctor and patient is so important after a diagnosis of cardiomyopathy. My goal is to explain the case and establish a relationship of trust that leads to the patient’s incubation for appropriate follow-up. This can mean walking a fine line between conveying the severity of the diagnosis to the patient and avoiding the feeling of death, which many people will feel when they are told they have heart failure.

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Although I make sure my patients understand that they have a serious, life-threatening condition, I would add that many people with cardiomyopathy these days live long and satisfying lives.

Studies show that people are living longer in part because of a large number of new innovations. Most notably, newer drugs called SGLT2 inhibitors. Initially developed to treat type 2 diabetes, it has also been found to prolong and improve the lives of heart failure patients; They also have few side effects and can be used for heart failure patients with low or normal ejection fraction.

Unfortunately, because these drugs are new — the first SGLT2 inhibitor approved by the Food and Drug Administration in 2020 to treat heart failure — many patients who potentially benefit from them do not take them, in some cases because many doctors, including Cardiologists, they have not yet modernized their practices but also due to the high co-payments and administrative burdens on physicians by insurance companies.

Many people get the initial diagnosis of cardiomyopathy after they experience difficulty breathing or swelling in their limbs due to excess fluid in the body. Once diagnosed, many patients enter a stable phase – but staying in this stable phase requires action. Lifestyle changes, such as losing weight, restricting salt intake and exercising, are essential to living a long, healthy life with cardiomyopathy, as are taking medications regularly as prescribed by your doctor.

Evidence suggests that taking four main classes of drugs can add three to eight years of lifeAnd the Plus the years added lifestyle changes. These drug classes include: beta-blockers (drugs ending in “-olol,” such as metoprolol), ACE inhibitors (ending in “-pril,” such as lisinopril) or ARBs (ending in “-artan,” such as losartan) Or the brand drug Entresto, MRAs such as spironolactone, and finally SGLT2 inhibitors (ending in “-fluzine”, such as empagliflozin and dapagliflozin). Physicians must explain both the many benefits and the few risks of medications while giving patients a sense of agency and ownership.

“You are the midfielder, we are your offensive line and we protect you from getting hit,” I often tell people.

Sometimes even the best efforts don’t work – or only work for a long time – and patients enter a more advanced stage of heart failure characterized by frequent hospitalizations, inability to tolerate medications due to low blood pressure and in some cases progressive failure of organs such as the kidneys and lungs. Patients experience gradual difficulty breathing, initially only when exercising and eventually during rest.

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When this happens, doctors may recommend surgical treatments, such as a heart transplant or implantation of mechanical pumps that are sewn into the patient’s heart to help pump blood throughout the body. Survival after heart transplantation is on average 13 years, with many patients living more than two decades. Mechanical pumps, called left ventricular assist devices or LVADs, have come a long way and can add years to life.

Heart transplants and ventricular assist devices (LVADs) both carry significant risks: rejection of the donor’s heart, infections, and cancers can affect heart transplant recipients; Bleeding, infections, and strokes affect LVAD recipients. Because the risks often outweigh the benefits, many patients are not good candidates for these treatments. At this point, patients may turn to palliative care that focuses on maximizing quality of life and care that focuses on comfort rather than just longevity, although patients with heart failure may benefit from palliative care at any stage of their disease.

Because cardiomyopathy remains a challenging and stressful disease, we need to do everything possible to prevent heart failure in the first place. For most people, this means controlling blood pressure and diabetes, losing weight and preventing other forms of heart disease, including abnormal heartbeats and heart attacks, which can lead to heart failure.

However, treatments for cardiomyopathy have turned it from a death sentence to a condition many people can live with better and for longer than ever before. Given advances in science and medicine, there is hope that the diagnosis will become less terrifying in the future. For this to happen, it is critical that patients receive the right care at the right time.

Haider C. He is the author of a bookThe state of the heart: exploring the history, science, and future of heart disease The book just publishedOur Scars Song: The Untold Story of Pain. “

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