JANUARY–MARCH 2024 HEARTBEAT® 9 The Heart of the Matter Cardiomyopathy describes a variety of conditions that can affect the heart muscle. The disease causes the heart muscle to thicken, become stiff, enlarge, thin out or become filled with substances that don’t belong. This makes it hard for the heart to pump blood properly. There are many causes, including a variety of heart disease conditions and infections to the heart. Additionally, heart attacks can lead to cardiomyopathy because of damage to the heart. Cardio- myopathy can affect people of all sexes, ages and races. It is estimated that as many as 1 in 500 adults has a form of cardiomyopathy. This number could be much higher due to underdiagnosis and misdiagnosis. The reason the disease often goes undi- agnosed is that many people with car- diomyopathy don’t have symptoms. Also, when people, especially younger ones, go to the doctor for a routine visit or to be treated for a cold or other minor illness, they likely won’t get an EKG, which is used to detect cardiomyopathy and other heart issues, according to Shaival Kapa- dia, M.D., a cardiologist at James River Cardiology in Virginia. Unfortunately, even if a person doesn’t have symptoms and is undiagnosed, car- diomyopathy is a serious condition that can lead to other complications including heart failure, sudden cardiac arrest, blood clots and heart valve disease. Delving Into the Thick of It Hypertrophic cardiomyopathy (HCM), the type Karlin has, is one of four main types of cardiomyopathies. “Think of the heart as a pump with its own plumbing and electrical system,” says Dr. Kapadia. “With HCM, the wall of the pump becomes abnormally thickened, which can lead to impairment of the heart’s ability to pump blood.” He notes that HCM is often due to genetics. If one parent has HCM, there’s a 50% chance their kids will have the genetic mutation for the disease. There are two different types of HCM: obstructive and non-obstructive. Obstructive HCM occurs when the wall between the two bottom cham- bers of the heart (the left and right ventricle) becomes thickened and blood is blocked (or obstructed) from flowing freely from the heart out into the body. Non-obstructive HCM occurs when the left ventricle itself becomes thick- ened and stiff. This makes it difficult for the ventricle to properly fill with enough blood. While the blood flow is not obstructed, the result is the same: a reduced amount of blood flowing with each heartbeat. About two-thirds of people diagnosed with HCM have the obstructive type. Karlin is one of those people. HCM can cause sudden death in adolescents and young adults (especially athletes). “When you hear about athletes collapsing on the field or court, one of the major causes of that electrical problem is [undiagnosed] hypertrophic cardiomy- opathy,” says Dr. Kapadia. “Competitive athletes tend to push harder, and when doing so, it increases their heart rate and blood pressure, which puts extra strain on the heart.” A Not-So-Obvious Issue For many people, the problem with HCM is that it isn’t always obvious. “The vast majority of people early on don’t have any symptoms,” says Dr. Kapadia. “When they do, the symptoms could be really subtle.” When symptoms do occur, they may include fatigue, shortness of breath, Shaival Kapadia, M.D., a cardiologist at James River Car- diology in Virginia, treats patients with cardiomy- opathy and other heart issues. He says there are two goals for treating cardiomyopathy: improving quality of life and ensur- ing life expectancy is close to normal. Photo courtesy of Dr. Shaival Kapadia
