Does cardiomyopathy require surgery?

Written by Liu Yong
Cardiology
Updated on September 17, 2024
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Firstly, whether myocardial disease requires surgery, we need to clarify the type of myocardial disease and the stage of myocardial disease, that is, the stage of heart function that has been affected.

There are many types of myocardial diseases, including dilated cardiomyopathy, ischemic cardiomyopathy, and restrictive cardiomyopathy, for instance. The treatment plans for different types of myocardial diseases are not exactly the same. For example, dilated cardiomyopathy is generally treated with medication, and only in the very late stages of dilated cardiomyopathy, or what is known as stage IV heart function, when conventional medication is ineffective, heart transplantation might be considered if a donor is available and conditions allow. However, currently, heart donors are extremely rare, making this option quite difficult to achieve. The latest advances in clinical research have introduced artificial mechanical hearts available for transplantation, but the costs of surgery are very high, and the technology is not very mature yet. Therefore, the chances and opportunities for surgery are not very great and must be decided based on the situation.

For other conditions, such as ischemic cardiomyopathy, if it is clearly caused by severe ischemia, we might consider addressing the factors causing myocardial ischemia, such as performing a coronary angiography. If there is severe coronary artery stenosis, we might consider implementing a coronary artery stent or coronary artery bypass grafting to alleviate the ischemic factors. In cases like restrictive cardiomyopathy, if there are severe restrictive factors contributing to the disease, surgical treatment might also be pursued.

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Written by Liu Ying
Cardiology
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What should be noted for dilated cardiomyopathy?

Patients with dilated cardiomyopathy should actively look for the cause of the disease and provide corresponding treatments, such as controlling infections, strictly limiting or abstaining from alcohol, treating relevant endocrine or autoimmune diseases, correcting electrolyte disorders, and improving nutritional imbalances, etc. In the early stages of dilated cardiomyopathy, although there is already enlargement of the heart and impairment of contractile function, there are no clinical manifestations of heart failure. At this stage, early pharmacological intervention should be actively implemented to slow down ventricular remodeling and further damage to the myocardium, delaying the progression of the disease. As the condition progresses, the patient's ventricular contractile function further decreases and clinical manifestations of heart failure appear. At this point, treatment should follow the guidelines for chronic heart failure. However, the specifics of the treatment and the choice of medication should be determined by a specialist based on the patient’s condition.

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Written by Liu Yong
Cardiology
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Late-stage symptoms of dilated cardiomyopathy

The so-called advanced stage refers to a phase where cardiac function has reached stage four. The common clinical manifestations of this stage are primarily those of heart failure, such as chest tightness and shortness of breath after activity, inability to lie flat at night, general edema, and even accumulation of fluid in the chest and abdominal cavity. Some patients with severe edema might experience abdominal distension, poor appetite, and even malnutrition, which are all manifestations of heart failure. Once cardiac function reaches stage four, patients with dilated cardiomyopathy are highly susceptible to malignant arrhythmias, such as ventricular tachycardia and ventricular fibrillation. These types of arrhythmias are a common cause of death in the late stages of dilated cardiomyopathy. Therefore, proactive prevention is crucial for these patients as they have a very poor prognosis, and it is essential to maintain active communication with their families.

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Written by Xie Zhi Hong
Cardiology
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Is dilated cardiomyopathy the same as heart disease?

Heart disease is divided into several major categories: the first category is cardiovascular disease, the second category is arrhythmia disorders, which are those caused by abnormalities indicated on an electrocardiogram, and the third category is caused by cardiac structural issues, such as dilated cardiomyopathy, which is a heart disease caused by structural problems in the heart. Therefore, we should understand that dilated cardiomyopathy is actually a type of heart disease; it is not the same. Thus, this question is relatively easy to answer, as dilated cardiomyopathy is just one type of heart disease.

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Written by Li Hai Wen
Cardiology
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What should I do if dilated cardiomyopathy is causing insomnia?

Dilated cardiomyopathy causing insomnia needs to be treated based on the cause of the insomnia. First, if it is simply poor sleep quality causing occasional insomnia, no special treatment is needed. However, if insomnia occurs daily and affects quality of life, sleep-improving medications such as eszopiclone or zopiclone may be taken under a doctor's guidance. Second, if caused by worsening heart failure symptoms, which lead to nocturnal respiratory distress and affect sleep, resulting in insomnia, the treatment for heart failure should be intensified under a doctor's guidance, for instance, by increasing diuretic treatment or adjusting medications. Improving heart failure symptoms naturally enhances sleep quality. (If medication is required, please do so under the guidance of a doctor)

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Written by Tang Li
Cardiology
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How is hypertrophic cardiomyopathy treated?

The treatment of hypertrophic cardiomyopathy aims to improve symptoms, reduce complications, and prevent sudden death. The methods include improving ventricular compliance by reducing outflow tract obstruction, preventing thromboembolic events, and identifying high-risk patients for sudden death. Treatment needs to be individualized, and the main treatments include the following aspects: 1. Medication treatment. Drug treatment is fundamental, and drugs targeting outflow tract obstruction mainly include receptor blockers and non-dihydropyridine calcium channel blockers. For patients with congestive heart failure, targeted treatment is required. Anticoagulation treatment is necessary for patients with atrial fibrillation, and it is worth noting that for patients with chest discomfort, care should be taken to exclude outflow tract obstruction when using nitrate drugs to avoid exacerbation after use. Non-drug treatments include: 1. Surgical treatment: For patients with ineffective drug treatment and heart function class three to four, if there is severe outflow tract obstruction, septal myectomy should be considered. Currently, surgery is listed as the preferred treatment for suitable patients in consensus guidelines in both America and Europe. 2. Alcohol septal ablation; 3. Pacing therapy.