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Types of Cardiomyopathy: Hypertrophic, Dilated & Restrictive

This article has been medically reviewed by:
Bernard Gros, M.D., F.A.C.C.
Bernard Gros, M.D., F.A.C.C.

Cardiomyopathy is a group of complex heart muscle diseases that hinder blood flow from the heart to the rest of the body. An estimated 1 in 500 people has cardiomyopathy¹, although many cases go undiagnosed.

Some types of cardiomyopathy are genetic and cannot be prevented, while others are acquired and can be prevented. 

If left untreated, cardiomyopathy can lead to life-threatening complications, such as heart failure. Depending on how far progressed the disease is, patients may be treated with medications, heart-healthy lifestyle changes, a surgically-implanted device or surgery in severe cases.

Types of Cardiomyopathy

The three main types of cardiomyopathy include hypertrophic cardiomyopathy, dilated cardiomyopathy and restrictive cardiomyopathy. 

Ischemic Vs. Non-ischemic

Cardiomyopathy² can be ischemic (cause reduced blood flow and oxygen) or nonischemic (no blood flow obstruction) in nature.

Ischemic cardiomyopathy results from heart damage due to coronary artery disease, atherosclerosis (plaque buildup in the arteries) or heart attacks. Nonischemic cardiomyopathy often results from infection, reactions to medications and autoimmune diseases.

Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy is a genetic type of cardiomyopathy that causes the heart muscle to thicken (hypertrophy.) This hypertrophied wall can obstruct blood flow, which is called obstructive hypertrophic cardiomyopathy. If blood flow is not restricted, this is called nonobstructive hypertrophic cardiomyopathy.

This type of cardiomyopathy can develop at any age and is generally inherited through family history.

Signs and symptoms of hypertrophic cardiomyopathy include:

  • Chest pain
  • Shortness of breath from minimal physical exertion
  • Loss of consciousness
  • Fatigue
  • Heart arrhythmias (abnormal heartbeat)
  • Swelling in the legs, feet and abdomen

Dilated Cardiomyopathy

Dilated cardiomyopathy, nonischemic cardiomyopathy, is the most common type of cardiomyopathy. This condition causes the heart ventricles (chambers that pump blood out of the heart) to become enlarged, thin and stretched³. 

Blood cannot properly pump out of the heart and throughout the rest of the body when the heart chambers are too narrow.

Causes of dilated cardiomyopathy include: 

  • Coronary artery disease (heart disease) that causes blockages in the coronary arteries
  • Untreated hypertension (high blood pressure) 
  • Excessive use of alcohol or illegal drugs
  • Diabetes
  • Hepatitis
  • Heart arrhythmia (abnormal heart rhythm)
  • Infections in the heart muscle
  • Exposure to heavy metals

Signs and symptoms of dilated cardiomyopathy include:

  • Chest pain
  • Shortness of breath from minimal physical exertion
  • Shortness of breath when lying down
  • Loss of consciousness
  • Fatigue
  • Heart palpitations and heart fluttering (heart arrhythmia)
  • Swelling in the legs, feet and abdomen
  • Blood clots

Restrictive Cardiomyopathy

Restrictive cardiomyopathy⁴ is a type of heart muscle disease that causes the heart chambers to stiffen over the years. The heart muscle is still able to contract and pump blood, but the heart chambers cannot relax after each heartbeat. This causes the heart to fill with blood, which forces blood back into the circulatory system.

In many cases, untreated restrictive cardiomyopathy leads to heart failure. 

Causes of restrictive cardiomyopathy include:

  • Rare genetic conditions
  • Buildup of scar tissue on the heart
  • Chemotherapy and other radiation treatments 
  • Sarcoidosis, an inflammatory disease

Signs and symptoms of restrictive cardiomyopathy include:

  • Chest pain
  • Cough
  • Shortness of breath from minimal physical exertion
  • Loss of consciousness
  • Fatigue
  • Heart palpitations and heart fluttering (heart arrhythmia)
  • Swelling in the legs, feet and abdomen
  • Blood clots

Diagnosis of Cardiomyopathy

If you experience chest pain or other heart-related symptoms, we encourage you to schedule an appointment with our experienced cardiologist (Dr. Bernard Gros.)

When diagnostic testing is necessary, UCF Health’s East Orlando location is equipped with a noninvasive cardiovascular lab, where your doctor can perform or administer any of the following tests:

  • ECG (electrocardiogram) – An ECG measures electrical activity in the heart. This test can reveal heart arrhythmias and injuries in the heart muscle. (What’s the difference between an echocardiogram and an ECG?)
  • Stress echocardiograms – During a stress echocardiogram, a patient rides a treadmill or stationary bike while hooked up to an ECG machine to record heart activity, blood pressure and blood flow. 
  • Chest x-rays – Chest x-rays can show enlargement in the heart muscle.
  • Blood tests – Blood may be drawn to test organ function, including the kidneys and liver, check iron levels and measure B-type natriuretic peptide (BNP.) (BNP is a protein in the blood that rises in heart failure, which may occur with cardiomyopathy.)

Treatment of Cardiomyopathy

If cardiomyopathy is diagnosed, treatment may include medication, a surgically-implanted device or open-heart surgery to restore blood flow and heart function. In severe cases, a heart transplant may be necessary.

Lifestyle Changes

Making heart-healthy lifestyle changes is an essential part of treating cardiomyopathy symptoms and protecting the heart. 

  • Adopt a heart-healthy diet with a variety of fruits, vegetables and healthy fats. Reduce your daily sodium, trans fat, saturated fat and refined carb intake.
  • Exercise regularly to promote proper blood flow. Try an aerobic exercise (walking, running, biking or swimming) for 30 minutes, 5 days a week.
  • Kick habits that contribute to cardiomyopathy and other heart conditions. Smoking, chewing tobacco, excessive alcohol consumption and using illegal drugs can increase the risk of cardiac events.

Medications

If lifestyle changes alone are not sufficient, medications may be prescribed. Potential medications include:

  • Beta blockers to reduce heart rate and prevent ventricular tachycardia (racing heart) 
  • Anticoagulants (blood thinners) to prevent blood clots
  • Diuretics to remove excess fluid from the body
  • Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) to manage blood pressure

Surgically-Implanted Devices

Patients who have numerous risk factors for cardiac arrest or sudden death may be prescribed one of the following devices:

  •  Pacemaker – A pacemaker is a portable device implanted into the chest to deliver electrical signals to the heart and regulate the heartbeat.
  • Implantable cardioverter defibrillator (ICD) – The ICD device is implanted through the chest into the heart to continuously monitor the heart rate and defibrillate (send electric shocks) if necessary. 

Surgery

When medical treatment is not sufficient, surgery may be necessary. Open-heart surgery aims to reduce or remove symptoms associated with cardiomyopathy. This may also include surgically implanting a device or performing a heart transplant.

Schedule an appointment with an experienced cardiologist today.

Our cardiologist in Orlando, Dr. Bernard Gros, places great emphasis on preventive cardiology. He takes every measure to reduce the risk of cardiac episodes before they occur. 

Dr. Gros will create a personalized treatment plan that incorporates an effective treatment method (medication or a device) if necessary, along with sustainable lifestyle changes to improve your overall health. 

Taking measures to protect the heart and knowing how to prevent heart disease as well as other cardiac events is key. We will create a plan to minimize or eliminate risk factors and make your symptoms manageable.

Schedule an appointment with our convenient online scheduling tool.

Sources:

  1. “Cardiomyopathy.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 9 Dec. 2019, https://www.cdc.gov/heartdisease/cardiomyopathy.htm#:~:text=As%20many%20as%201%20of%20500%20adults%20may%20have%20this%20condition.&text=Males%20and%20females%20of%20all,in%20males%20than%20in%20females.&text=Hypertrophic%20cardiomyopathy%20is%20thought%20to,inherited%20or%20genetic%20heart%20disease. 
  2. “What Is Cardiomyopathy in Adults?” Www.heart.org, 2 June 2022, https://www.heart.org/en/health-topics/cardiomyopathy/what-is-cardiomyopathy-in-adults. 
  3. Dilated Cardiomyopathy – Statpearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK441911/. 
  4. Muchtar, Eli, et al. “Restrictive Cardiomyopathy.” Circulation Research, 15 Sept. 2017, https://www.ahajournals.org/doi/10.1161/circresaha.117.310982.