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Cardiomyopathy is the broad term used to describe heart muscle disease that makes it harder for the heart to pump blood. It may lead to arrhythmia, which is an irregular heartbeat, or heart failure.

female heart provider in lab coat talking to female patient in exam room

What is cardiomyopathy?

With cardiomyopathy, the heart muscle becomes weak, making it difficult for the muscle to pump adequately for the heart. Because cardiomyopathy is caused by numerous conditions, there are multiple signs, symptoms, and treatments.

What are the symptoms of cardiomyopathy?

The signs of cardiomyopathy are not always obvious, especially in the beginning stages. However, as the condition progresses, symptoms start to appear, which could include:

  • Shortness of breath
  • Swelling in legs, feet, and ankles
  • Bloating in the abdomen
  • Coughing while lying down
  • Fatigue
  • Arrhythmia (irregular heartbeat)
  • Pounding or racing heartbeat
  • Chest discomfort
  • Dizziness or lightheadedness
  • Fainting

What are the main types of cardiomyopathy?

Common types of cardiomyopathy are coronary artery disease related to heart attacks and broken heart syndrome caused by stress and pain. 

Dilated cardiomyopathy (DCM) impacts all four chambers of the heart, the atria, and the ventricles. This condition prevents the heart from beating effectively. If left untreated, it can lead to blood clots in the heart, leaky heart valves, arrhythmia, heart attack, or heart failure

There are multiple types of dilated cardiomyopathy that include:

  • Ischemic cardiomyopathy: The most common type of dilated cardiomyopathy caused by coronary artery disease
  • Alcoholic cardiomyopathy: Caused when some patients are particularly senstive to alcohol use
  • Peripartum cardiomyopathy: A rare condition that develops in women at the end of their pregnancy 

Hypertrophic cardiomyopathy occurs when the muscle of the heart’s left ventricle enlarges and restricts blood flow to the rest of the body. Blood can also leak through the valves. It’s typically an inherited form.

This condition, called stress cardiomyopathy, is caused by a sudden surge of stress hormones, typically brought on by events such as divorce, death, breakups, or shock. Broken heart syndrome symptoms often mirror those of a heart attack, including chest pain and arrhythmia, but there is no evidence of heart artery blockage.

Restrictive cardiomyopathy is when the heart muscle becomes rigid and stiff, sometimes due to scar tissue or previous radiation therapy, preventing the muscle from relaxing and the heart from filling with blood. 

Complications from cardiomyopathy

If left untreated, cardiomyopathy can cause serious complications, including: 

  • Blood clots: These may form if the heart cannot adequately pump blood, causing it to become relatively stagnant and clot. These clots can break off and block blood flow to organs, including the brain (stroke) and lungs (pulmonary embolism)
  • Stroke: If a blood clot breaks off and travels to the brain, it can lodge itself inside an artery and cut off blood flow to the brain. This is a life-threatening emergency requiring immediate medical intervention
  • Pulmonary embolism: If a blood clot breaks off and travels to the lungs, it can lodge itself inside an artery and interrupt blood flow to the lungs and affect the body’s ability to obtain oxygen. This is a life-threatening emergency requiring immediate medical intervention
  • Heart failure: The heart cannot pump well enough to properly move blood through the body
  • Organ failure and limb loss: If the heart cannot pump blood effectively through the body, organs do not receive the necessary nutrients they need to perform, and may begin to fail. Blood clots caused by cardiomyopathy may also cause blood flow to organs or limbs to be cut off, resulting in tissue death and potential removal or amputation
  • Heart valve problems: Due to the heart muscle becoming enlarged or damaged, valves may not be able to close properly
  • Heart attack and sudden death: Cardiomyopathy can either disrupt heart rhythms or cause the heart to stop beating effectively, which can lead to sudden death

When to call your doctor

Call your doctor if you experience any symptoms associated with cardiomyopathy. If you are experiencing symptoms such as difficulty breathing, chest pain, or difficulty speaking, these may be a sign of a life-threatening complication like a stroke or heart attack. In these cases, call 911 or the local emergency number immediately.

Our Mass General Brigham cardiologists and surgeons are experts in helping patients manage and treat heart disease, including cardiomyopathy. 

Risk factors and causes of cardiomyopathy

Causes of cardiomyopathy can range from genetics to heart disease. Some conditions that can be a cardiomyopathy risk factor include:

  • High blood pressure
  • Heart attack or other heart conditions
  • Uncontrolled, fast heart rate (tachycardia)
  • Nutritional deficiencies
  • Cancer treatments, including chemotherapy and radiation
  • Diseases including diabetes, thyroid disease, hemochromatosis (when the body stores too much iron), and connective tissue disorders
  • COVID-19 infections
  • Obesity
  • Thyroid or metabolic disorders
  • Pregnancy complications
  • Too much alcohol
  • Drug use
  • Family history

Diagnosis of cardiomyopathy

Your doctor will perform a physical examination and ask questions about family medical history to begin the diagnosis of cardiomyopathy. It may take several tests to rule out or confirm cardiomyopathy. Standard diagnostic tests include:

  • Chest X-ray, to show if there is an enlargement of the heart
  • Stress test, commonly performed on the treadmill to monitor the heart rate, rhythm, and blood pressure while walking
  • Cardiac catheterization, which inserts a thin tube into the blood vessels to measure the pressure within the heart’s chambers to detect any blockages
  • Echocardiogram
  • Electrocardiogram
  • Cardiac magnetic resonance imaging (MRI)
  • Cardiac CT scan
  • Blood tests
  • Genetic testing

Treatment for cardiomyopathy

Treatment for cardiomyopathy will depend on the type of cardiomyopathy and its severity. Treatment will likely include managing symptoms, reducing complications from cardiomyopathy, and preventing it from worsening. 

Medications such as beta-blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers, mineralocorticoid inhibitors, sodium-glucose cotransporter-2 (SGLT2) inhibitors and diuretics can be prescribed to manage and reduce symptoms.

Minimally invasive procedures and surgery can improve cardiomyopathy symptoms and outcomes in certain types and cases. They include: 

  • Septal ablation: A minimally invasive procedure used to treat hypertrophic cardiomyopathy that injects alcohol into the heart muscle to improve blood flow
  • Pacemaker: An implanted device that improves heart rhythm 
  • Ventricular assist device: An implanted device that helps the heart pump blood  
  • Heart transplant: When no other treatments or procedures are effective, a heart transplant could be recommended 
  • Septal myectomy: Septal myectomy is open heart surgery that treats hypertrophic cardiomyopathy (HCM), a condition where the heart's left ventricle muscle becomes abnormally thick, making it harder for blood to flow properly. Hypertrophic cardiomyopathy forces the heart to work harder, and it can also affect the mitral valve, causing blood to flow backward. During this surgery, doctors remove the thickened part of the heart's wall to improve blood flow and relieve the blockage caused by HCM

Preventing cardiomyopathy

Preventing cardiomyopathy requires managing your risks and heart health. While genetic conditions can’t be prevented, following a heart-healthy lifestyle can help improve your outcome:

  • Avoid alcohol and drug use
  • Manage high blood pressure, high cholesterol, and diabetes
  • Eat a healthy diet rich in whole grains, fruits, and vegetables 
  • Get regular exercise
  • Maintain healthy sleeping habits
  • Reduce your stress levels 


There are numerous symptoms of cardiomyopathy, which may not appear until the condition worsens. Some of the signs of cardiomyopathy include shortness of breath, fatigue, dizziness, and lightheadedness, swelling in the feet and ankles, and chest pains. Others may experience fainting, heart murmurs, or irregular heartbeats.

Many conditions can cause cardiomyopathy but coronary artery disease and previous heart attacks are common factors. Family history plays a role, as well as lifestyle factors, such as alcohol or drug abuse. The exact cause of cardiomyopathy may never be determined.

If left unmanaged, cardiomyopathy leads to serious complications. These complications range from blood clots in the heart, heart valve issues, heart failure, and even heart attack or sudden death. 

You may wonder how long you can live with cardiomyopathy. The good news is, if caught early and with a treatment plan, it is possible to live a normal life expectancy with cardiomyopathy.

Heart failure means the heart is weakened and unable to pump blood as it should. Cardiomyopathy is a disease of the heart muscle, which is a cause of heart failure.