How is cardiomyopathy diagnosed?

Dr. Jeanne Morrison, PhD
Family Practitioner

The first step in diagnosing cardiomyopathy may be a physical exam in which your doctor will look for symptoms such as swelling in your legs and irregularities in your heartbeat. Afterwards, several tests can determine the shape of your heart and whether blood is flowing properly. These may include a chest x-ray, an electrocardiogram, an echocardiogram, a CT scan or an MRI. In some cases your doctor may perform a cardiac catheterization in order to examine a piece of heart tissue.

Patients who present with cardiomyopathy usually present with heart failure. The symptoms are related to the severity of the disease process. Therefore, some patients who have weak hearts or mild cardiomyopathies can be asymptomatic. Patients who have severe cardiomyopathies will present with shortness of breath, low exercise tolerance and general weakness. They may or may not have chest pain associated with this. The number one tool doctors use is called a cardiac ultrasound This allows us to actually see the heart, determine that it is weak, and many times that the heart is enlarged. Ultrasound help us follow the disease process and response to medical therapy. There are other modalities including x-ray studies, and cardiac catheterization to determine how the vessels feeding the heart are doing, as well as response to medications. There are certain genetic studies that are used as well to help us diagnose cardiomyopathy and the relationship to the genetic predisposition. A great deal of research now is focusing on how we can diagnose patients who are at risk for developing cardiomyopathy before they actually develop symptoms of this disease.

The condition usually can be diagnosed by characteristic physical findings, electrocardiogram (EKG), echocardiogram, and, if doubt still exists, cardiac catheterization and radionuclide angiography. A biopsy of the heart wall tissue may help distinguish between the different types of cardiomyopathy.

Cardiomyopathy can be diagnosed by common cardiology tests. These tests include noninvasive imaging such as echocardiogram or ultrasound. Other more sophisticated tests may also be used, including cardiac CT and cardiac MRI. Certain blood tests are also necessary to rule out infectious agents and endocrine causes as well as toxic agents to the heart.

When there is a concern about the possibility of cardiomyopathy in a patient, a cardiologist will order a test called an echocardiogram. An echocardiogram is a sound wave test of the heart which accurately shows the strength of the heart muscle, size of the heart and the functioning of the heart valves. The overall strength of the heart muscle is reported out in a number called the ejection fraction, which is the percentage of blood the heart ejects with every beat. A normal ejection fraction is 50 70 percent.

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