American Medical Association Family Medical Guide - American Medical Association [351]
Nutritional Cardiomyopathy
Heart muscle can be damaged by toxins. In the United States, the most severe form of cardiomyopathy caused by toxins occurs among people who drink alcohol heavily. Excessive intake of alcohol can poison the heart muscle. In rare cases, inadequate intake of vitamin B1 (which is often deficient in heavy drinkers) causes cardiomyopathy.
Symptoms
The symptoms of nutritional cardiomyopathy vary greatly from one person to another. Symptoms may include palpitations (heartbeats that you’re aware of) or an irregular or very rapid heartbeat, or swollen hands and feet. Because damage to the heart muscle can lead to disorders such as atrial fibrillation (see page 581) and heart failure (see page 570), a person also may have symptoms of these disorders.
Treatment
A doctor will recommend that a person with nutritional cardiomyopathy stop drinking alcohol. The doctor may also prescribe dietary changes or vitamin supplements. The condition improves in about one third of the people who give up alcohol. In the remaining two thirds, treatment is the same as that for heart failure.
Hypertrophic Cardiomyopathy
Defective cells in the heart muscle, possibly as a result of a congenital (present at birth) abnormality, may cause the heart muscle to weaken. To compensate for the weakened heart muscle, the walls of the heart may thicken. In severe cases, the thickened walls can interfere with blood flow into and out of the heart.
Symptoms
Symptoms of hypertrophic cardiomyopathy include fatigue, chest pain, shortness of breath, and palpitations (heartbeats that you’re aware of).
Diagnosis
To diagnose hypertrophic cardiomyopathy, a doctor will order diagnostic tests such as a chest X-ray; an electrocardiogram (ECG; see page 559), a recording of the electrical activity of the heart; and an echocardiogram (see page 561), an ultrasound examination of the heart.
Treatment
There is no cure for hypertrophic cardiomyopathy, but symptoms can be relieved with heart disease medications such as beta blockers, which help slow the heart rate, and diuretics, which help eliminate excess fluid from the body. Calcium channel blockers help the heart fill with blood more efficiently. If symptoms become severe, especially if blood flow from the heart is obstructed, surgery to remove some of the excess heart muscle can significantly improve symptoms. Some people who have heart failure as a result of hypertrophic cardiomyopathy will need a heart transplant (see page 573).
Acute Pericarditis
Pericarditis is inflammation of the pericardium, the membrane that surrounds the heart. When the pericardium becomes inflamed, fluid can collect in the space between the membrane and the heart (called pericardial effusion). The inflammation in acute pericarditis is usually caused by a viral infection, but it can also result from tuberculosis (see page 663), rheumatic fever (see page 432), a disease of connective tissue such as lupus (see page 920), or chronic kidney failure (see page 817). In rare cases, acute pericarditis follows a heart attack (see page 567) or a chest injury. Pericarditis often occurs along with more serious illness and occasionally can follow open-heart surgery.
Symptoms
The main symptom of acute pericarditis is severe pain, usually in the center of the chest, that may radiate to the left shoulder. The pain of acute pericarditis becomes worse if you breathe deeply, cough, or twist your body. Chest pain, especially if it occurs along with breathing difficulty, can be a symptom of a serious illness such as pneumonia (see page 660), pulmonary embolism (see page 606), and heart attack.
You may also be short of breath and have a slight fever. As fluid collects around the heart, it creates pressure that can interfere with the normal filling of the heart with blood and cause a severe decrease in the volume of blood pumped by the heart, which can lead to death.
WARNING!
Chest Pain
Chest pain can be a symptom of a heart attack. If you have