Ischemic cardiomyopathy (CM) is the most common type of dilated cardiomyopathy. In Ischemic CM, the heart's ability to pump blood is decreased because the heart's main pumping chamber, the left ventricle, is enlarged, dilated and weak. This is caused by ischemia - a lack of blood supply to the heart muscle caused by coronary artery disease and heart attacks.
Symptoms may include:
Major risk factors of heart disease, such as family history, high blood pressure, smoking, diabetes, high blood cholesterol, and obesity can also place one at increased risk for cardiovascular disease and ischemic cardiomyopathy.
CM is diagnosed based on your medical history (symptoms and family medical history), physical exam, and other tests. Specific tests may include blood tests, electrocardiogram (ECG), chest X-ray, echocardiogram, exercise stress test, cardiac catheterization, CT scan, MRI scan, and radionuclide studies.
Occasionally, a myocardial biopsy may be performed to determine the cause of cardiomyopathy. During a myocardial biopsy, small tissue samples are taken from the heart and examined under a microscope to determine the cause of the cardiomyopathy.
Treatment of ischemic CM is aimed at treating coronary artery disease, improving cardiac function and reducing heart failure symptoms. Patients usually take several medications to treat CM. Doctors also recommend lifestyle changes to decrease symptoms and hospitalizations and improve quality of life. In addition, devices and surgery may be advised.
Medications are used for two reasons:
To manage heart failure, most people improve by taking a beta-blocker and ACE inhibitor even when not having symptoms. If symptoms occur and/or worsen,digoxin, diuretics, and aldosterone inhibitors may be added. Other medications will be added as needed. For example, if you have an arrhythmia, your doctor may give you a medication to control your heart rate or lessen the occurrence of arrhythmia. Or, blood thinners may be prescribed to prevent complications when a blood clot develops in the lower heart chamber after a heart attack. Your doctor will discuss what medications are best for you.
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Both devices may be combined in a single unit, usually labeled CRT-D.