From the Guidelines
Cardiomyopathy is caused by a wide range of factors, including genetic mutations, coronary artery disease, long-term high blood pressure, and various other conditions that damage the heart muscle, as outlined in the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1. The causes of cardiomyopathy can be categorized into several groups, including:
- Genetic mutations, which can be inherited and affect the heart's structure and function from birth
- Coronary artery disease and heart attacks, which can damage the heart muscle and lead to cardiomyopathy
- Long-term high blood pressure, which can put extra strain on the heart and lead to cardiomyopathy
- Viral infections of the heart, such as myocarditis, which can damage the heart muscle and lead to cardiomyopathy
- Excessive alcohol consumption, drug abuse, and certain chemotherapy medications, which can also damage the heart muscle and lead to cardiomyopathy
- Metabolic disorders, such as thyroid disease or diabetes, which can increase the risk of developing cardiomyopathy
- Inflammatory conditions, such as sarcoidosis and autoimmune diseases, which can damage the heart muscle and lead to cardiomyopathy
- Nutritional deficiencies, particularly thiamine, selenium, and iron, which may contribute to cardiomyopathy development
- Pregnancy-related cardiomyopathy, which can occur in some women during the final month of pregnancy or within five months after delivery According to the 2022 AHA/ACC/HFSA guideline, other potential nonischemic causes of heart failure include chemotherapy and other cardiotoxic medications, rheumatologic or autoimmune conditions, endocrine or metabolic disorders, familial cardiomyopathy or inherited and genetic heart disease, heart rhythm-related conditions, hypertension, infiltrative cardiac disease, myocarditis, peripartum cardiomyopathy, stress cardiomyopathy, and substance abuse 1. It is worth noting that the 2012 American Heart Association scientific statement on animal models of heart failure also discusses the various causes of cardiomyopathy, including coronary artery disease, long-standing hypertension, myocarditis, Chagas disease, chemotherapeutic drugs, sustained and inappropriate tachycardia, autoimmune disorders, endocrine disorders, excessive alcohol consumption, nutritional deficiencies, neuromuscular disorders, and peripartum cardiomyopathy 1. However, the 2022 AHA/ACC/HFSA guideline provides more up-to-date and comprehensive information on the causes of cardiomyopathy. Therefore, it is essential to consider these various causes when evaluating and managing patients with cardiomyopathy, in order to provide the most effective treatment and improve patient outcomes, as recommended by the 2022 AHA/ACC/HFSA guideline 1.
From the Research
Causes of Cardiomyopathy
- Cardiomyopathy can be primary (genetic, mixed, or acquired) or secondary (e.g., infiltrative, toxic, inflammatory) 2, 3
- Genetic mutations impacting fundamental myocardial functions can cause primary cardiomyopathy 4
- Environmental factors and metabolic disorders, such as diabetes, may also lead to the occurrence of cardiomyopathy 5, 4, 6
- Diabetes mellitus can aggravate the clinical features of hypertrophic cardiomyopathy and worsen the prognosis of heart failure patients 5, 6
- Systemic disorders that result in widespread cardiac damage can also cause cardiomyopathy 4
Types of Cardiomyopathy
- Dilated cardiomyopathy: can be genetic or acquired and typically presents with classic symptoms of heart failure with reduced ejection fraction 3
- Hypertrophic cardiomyopathy: the most common primary cardiomyopathy, can cause exertional dyspnea, presyncope, atypical chest pain, heart failure, and sudden cardiac death 3
- Restrictive cardiomyopathy: much less common and often associated with systemic disease 3
- Arrhythmogenic right ventricular cardiomyopathy: a rare variant of cardiomyopathy 2, 3