Patients diagnosed with Restrictive Cardiomyopathy will present with the following signs and symptoms:

• Shortness of breath
• Exercise intolerance
• Chronic fatigue
• Paroxysmal Nocturnal Dyspnea (PND)
• Abdominal distention
• Bilateral peripheral edema
• Palpitation
• Orthostatic hypotension

Patients diagnosed with Dilated Cardiomyopathy will present with the following signs and symptoms:

• Shortness of breath
• Fatigue
• Orthopnea and PND
• Edema
• Angina
• Anemia
• Hypertension

Majority of patients with Hypertrophic Cardiomyopathy (HCM) are asymptomatic. The following symptomatology may be seen in patients with HCM:

• Dyspnea
• Pre-syncope or syncope
• Chest pain
• Orthopnea
• Dizziness
• Paroxysmal Nocturnal Dyspnea (PND)
• Palpitations
• Sudden death

• Fatigue

  These signs and symptoms include: Shortness of breath or trouble breathing, especially with physical exertion Fatigue (tiredness) Swelling in the ankles, feet, legs, abdomen, and veins in the neck Other signs and symptoms may include dizziness; light-headedness [web.archive.org]

  Symptoms: Patients with cardiomyopathy will typically present with dyspnea, orthopnea, paroxysmal nocturnal dyspnea, bilateral edema, and fatigue. [symptoma.com]

  Mental fatigue can manifest as somnolence, lethargy, or directed attention fatigue.[4] Fatigue and 'feelings of fatigue' are sometimes confused.[5] Unlike weakness, fatigue usually can be alleviated by periods of rest. [en.wikipedia.org]

  Symptoms of DCM can occur at any age and may include: Heart failure symptoms ( shortness of breath and fatigue ). Swelling of the lower extremities. Fatigue (feeling overly tired). Weight gain. [medicinenet.com]

• Congestive Heart Failure

  Unfortunately, some women never recover and go on to develop chronic congestive heart failure with a death rate of 85% within five years. [womensheart.org]

  This is technically improper use of the term cardiomyopathy; however, it is much easier to say/write than "chronic systolic congestive heart failure from ischemic heart disease." [healio.com]

  The end result of this is congestive heart failure—the heart cannot pump enough blood for the body's organs to function properly. The December 15, 2004, issue of JAMA includes an article about cardiomyopathy. [jamanetwork.com]

  Some of these can also help the heart pump more effectively. In very few people with cardiomegaly and severe congestive heart failure, a heart transplant may be recommended. [m.webmd.com]

  CHF w cardiomyopathy Congestive cardiomyopathy Congestive heart failure (chf) with cardiomyopathy Congestive heart failure due to cardiomyopathy Congestive obstructive cardiomyopathy Dilated cardiomyopathy Dystrophic cardiomyopathy Endomyocardial disease [icd9data.com]

• Pallor

  Affected individuals may also experience excessive sweating, fatigue, wheezing, and paleness of the skin (pallor). [rarediseases.org]

• Ankle Swelling

  It results in reduced blood flow from the heart and can lead to symptoms of heart failure, such as breathlessness, tiredness and ankle swelling, as well as heart rhythm problems. [nhs.uk]

• Coronary Atherosclerosis

  Ischemic cardiomyopathy is generally ascribed to epicardial coronary atherosclerosis, but it can also occur in any vasculitic process (eg, Takayasu's arteritis), congenital abnormalities (including aberrant coronary arteries), embolic conditions (eg, [clevelandclinicmeded.com]

• Dyspnea

  Symptoms: Patients with cardiomyopathy will typically present with dyspnea, orthopnea, paroxysmal nocturnal dyspnea, bilateral edema, and fatigue. [symptoma.com]

  However, after 10 infusions the patient developed dyspnea, edema of the legs, ascites and a weight gain of 10 kg because of a decompensated heart insufficiency with a reduced ejection fraction from formerly 48%-50% to 15%. [ncbi.nlm.nih.gov]

  Symptoms of heart failure may include shortness of breath, fatigue, cough, orthopnea, paroxysmal nocturnal dyspnea, and edema. This presentation is common in patients with dilated cardiomyopathy. [aafp.org]

• Exertional Dyspnea

  dyspnea, angina, syncope, sudden death Systolic murmur ± mitral regurgitation murmur, S4 Bifid carotid pulse with a brisk upstroke and rapid downstroke Exertional dyspnea and fatigue LV ± RV failure Functional AV valve regurgitation ECG Nonspecific ST [merckmanuals.com]

  […] heart failure via the following mechanisms: Right-sided heart failure : decreased rRV output → systemic circulation congestion → clinical features of right-sided heart failure (backward failure with predominant systemic congestion) Clinical features Exertional [amboss.com]

  dyspnea. 2,3 Thus, a high index of suspicion is necessary for diagnosis. [scielo.mec.pt]

• Pleural Effusion

  Associated pleural effusions may also be seen. [radiopaedia.org]

  Pleural effusions may occur when fluid also accumulates in the pleural cavity. Edema may also be found in the cornea of the eye with glaucoma, severe conjunctivitis or keratitis or after surgery. [en.wikipedia.org]

  Pulmonary multi-detector computed tomography angiography excluded acute pulmonary embolism but revealed bilateral pulmonary infiltration and pleural effusion suggesting acute pulmonary edema. transthoracic echo-cardiography (TTE) revealed four-chamber [scielo.mec.pt]

  Some patients will also have pleural effusions detected by decreased breath sounds at the bases and dullness to percussion. Women with cardiomyopathy not due to a viral cause will be afebrile. [clinicaladvisor.com]

  Common abnormalities seen on the chest radiograph include cardiomegaly, interstitial edema, pleural effusion(s), and evidence of previous sternotomy (sternal wires). [clevelandclinicmeded.com]

• Rales

  The recent RALES study11 has shown that the addition of 25 mg of spironolactone to conventional treatment in patients with an ejection fraction < 35% and a history of NYHA class IV heart failure is associated with a 30% reduction in the overall risk of [heart.bmj.com]

  Clinical features Exertional dyspnea Angina pectoris Palpitations Diffuse abdominal and peripheral edema Jugular venous distention Left ventricular impulse displacement Relative mitral valve regurgitation or tricuspid valve regurgitation S3 gallop Rales [amboss.com]

  Pulmonary auscultation showed bilateral rales and wheezing. Arterial gasometry revealed chronic respiratory alkalosis and oxygen saturation of 95%. [scielo.mec.pt]

  Classical symptoms of congestive heart failure and physical findings of tachycardia, tachypnea, rales in the lung bases and jugular venous distention make a diagnosis of cardiomyopathy or other heart disease likely. [clinicaladvisor.com]

• Tachypnea

  […] transcribe them (less-used variants are omitted): Group Term Combining forms Preponderance of transcriptions (major dictionaries) good eupnea eu- + -pnea yoop-NEE-ə[34][35][33][36] bad dyspnea dys- + -pnea disp-NEE-ə,[35][36][37] DISP-nee-ə[34][33] fast tachypnea [en.wikipedia.org]

  Classical symptoms of congestive heart failure and physical findings of tachycardia, tachypnea, rales in the lung bases and jugular venous distention make a diagnosis of cardiomyopathy or other heart disease likely. [clinicaladvisor.com]

  […] predominance being described in some reviews, 9,12 and in the pediatric population it is most common in the first year of life 38–40 with about 20% presenting in the neonatal period. 40 Infants with D CM often present with symptoms of HF 13,39–42 such as tachypnea [revportcardiol.org]

• Hepatomegaly

  Missense; Gln303Lys LCAD protein Location: Mitochondrial matirx Action: Catalyzes 1st step in mitochondrial β-oxidation of fatty acids Onset: Early childhood Episodes: Associated with fasting Hypoglycemia, Hypoketotic Cardiac arrest Clinical findings Hepatomegaly [neuromuscular.wustl.edu]

  […] compliance → ↓ diastolic filling → atrial congestion → atrial enlargement and severe diastolic dysfunction → systemic venous congestion Clinical features Most common: dyspnea Symptoms of right heart failure Jugular venous distention Peripheral edema, ascites Hepatomegaly [amboss.com]

  Additional symptoms may include fluid collection in the abdomen (ascites) and feet due to accumulation of fluid, congestion of the lungs, and an abnormally large liver (hepatomegaly). [rarediseases.org]

  13,40,42 Physical examination can reveal a displaced apical impulse, 13,41 muffled heart sounds 41 with a third heart sound, 13,41 a mitral regurgitation murmur 13,41 or signs of pulmonary congestion. 13 Signs of systemic venous congestion including hepatomegaly [revportcardiol.org]

• Hepatosplenomegaly

  The acute presentation is characterized by dyspnea, fever, myalgia, hepatosplenomegaly, and myocarditis. Chronic infection involves the esophagus, colon, and heart. [emedicine.medscape.com]

• Heart Failure

  Medicines and lifestyle changes are often needed to treat the symptoms of heart failure, angina and abnormal heart rhythms. [nlm.nih.gov]

  When heart failure become progressively worse, cardiac transplant may be the only option for RCM. [symptoma.com]

  Heart Failure with Reduced Ejection Fraction Also called systolic heart failure, heart failure with reduced ejection fraction is the most common type of heart failure. [nyulangone.org]

  Diastolic heart failure is typically treated with the same medical regimen as systolic heart failure. [aafp.org]

• Heart Disease

  […] artery disease or heart attack cause the disease. [heart.org]

  Some examples of cardiovascular diseases include ischemic heart disease, heart valve disease, cardiomyopathies, peripheral artery disease, congenital heart disease, and vascular disease of the kidneys. This study is located in Bethesda, Maryland. [nhlbi.nih.gov]

• Chest Pain

  We report the case of a 76-year-old man with a dual chamber pacemaker, admitted for acute chest pain and dyspnea and final diagnosis of TC. One month after index admission, the patient came back complaining again of chest pain. [ncbi.nlm.nih.gov]

  You develop chest pain, palpitations, faintness, or other new or unexplained symptoms. [medlineplus.gov]

  pain, especially after physical exertion or heavy meals; and heart murmurs. [web.archive.org]

  What Conditions Are Associated with Chest Pain? There are numerous conditions associated with chest pain. The following is only a small list of conditions that may lead to chest pain. [emedicinehealth.com]

• Palpitations

  Symptoms include palpitations and fainting after physical activity. Palpitations are feelings that your heart is skipping a beat, fluttering or beating too hard or too fast. ARVD usually affects teens or young adults. [heart.org]

  At a clinic visit 5 months later, she had received no ICD shocks and reported no symptoms of severe palpitations. [nejm.org]

  Palpitation Palpitation is an uncomfortable awareness of the heart beat. People may occasionally feel an extra beat or a skipped beat and this is usually normal. Sometimes an awareness of the heart beating does suggest and irregular heart rhythm. [ineaia.tripod.com]

  You develop chest pain, palpitations, faintness, or other new or unexplained symptoms. [medlineplus.gov]

  Illustration depicting the difference between a normal heart and hypertrophic cardiomyopathy Symptoms include shortness of breath, chest discomfort, palpitations, fatigue, dizziness or passing out. [barnesjewish.org]

• Tachycardia

  Junctional ectopic tachycardia (JET) is a rare form of arrhythmia that is most commonly seen during infancy. [ncbi.nlm.nih.gov]

  Palpitations (fluttering in the chest) due to abnormal heart rhythms (arrhythmias) such as atrial fibrillation or ventricular tachycardia. [my.clevelandclinic.org]

  A 68-year-old woman presented with symptoms of palpitations and was found to have frequent premature ventricular contractions and nonsustained ventricular tachycardia. [nejm.org]

  Tachycardia-induced cardiomyopathy Generally, when detected early, this type of cardiomyopathy is reversible once treatment of the tachycardia is successful. [emedicine.medscape.com]

The following laboratory work up and tests are done to investigate patients with impending cardiomyopathy:

• Chest X-ray – Chest radiographs will show whether the heart is enlarged.
• Echocardiography – This makes use of sound waves that determines size and functions of the heart. 
• Electrocardiogram (ECG) – This diagnostic modality uses chest electrodes to determine the electrical activity of the heart. This can detect abnormal rhythms and enlargement by voltage.
• Magnetic Resonance Imaging (MRI) – This makes use of magnetic fields and radio waves to determine a more detailed image of the heart [8].
• Cardiac Catheterization – This procedure makes use of a slender flexible tube inserted in the major vessels to the heart where a sample biopsy of the heart tissue may be taken for laboratory examination.
• Laboratory tests – blood test like the Beta-type natriuretic peptide (BNP) are tested for elevation due to heart failure which is seen as a common complication of cardiomyopathy. Troponin I may also be used to prognosticate heart failures in cardiomyopathy [9].

• Pericardial Effusion

  In both patients, echocardiography showed LV hypertrophy, biventricular systolic dysfunction, and a large amount of pericardial effusion. [ncbi.nlm.nih.gov]

  On plain radiographs consider: large pericardial effusion Promoted articles (advertising) [radiopaedia.org]

  Heart - pericardial effusion [# = 4, median year = 2008 (2000-2014)] The heart itself can be greatly affected in CD patients. Echocardiography has been used to show that there is a higher incidence of pericardial effusion in CD[ 93 ]. [doi.org]

  manifested by pericardial effusion. [46] It is diagnosed via EMB or with noninvasive modalities, such as the following: Echocardiography: The echocardiographic appearance of cardiac amyloidosis includes LV and right ventricular (RV) wall thickness with [emedicine.medscape.com]

• ST Elevation

  elevation (or, less commonly, ST depression), QT interval prolongation, T wave inversion, abnormal Q waves Laboratory: slightly ↑ troponin T;, ↑ BNP Echocardiography: apical left ventricular ballooning, ↓ LVEF Coronary angiography: usually no pathological [amboss.com]

  Markers of myocardial damage (troponin or creatine kinase cardiac isoenzymes) are elevated.[11] The ECG findings most commonly seen in myocarditis are diffuse T wave inversions; saddle-shaped ST-segment elevations may be present (these are also seen in [en.wikipedia.org]

  Heart - infarction [# = 5, median year = 2009 (2008-2015)] Acute myocardial infarction with ST-elevation and spontaneous coronary artery dissection can occur in young patients with CD[ 3, 136 ]. [doi.org]

  ST/T wave changes: ST-segment elevation or depression or T-wave inversion c. With or without normal global or regional LV and/or RV dysfunction on echocardiography or CMR d. [intechopen.com]

• Ventricular Bigeminy

  Frequent ventricular ectopics and ventricular bigeminy (seen with severe DCM). Ventricular dysrhythmias ( VT / VF ). ECG Examples Example 1 Ischaemic dilated cardiomyopathy: There is marked LVH (S wave in V2 > 35 mm) with dominant S waves in V1-4. [lifeinthefastlane.com]

• Right Bundle Branch Block

  TAD = terminal activation duration, IRBBB = incomplete right bundle branch block, CRBBB = complete right bundle branch block. Undiagnosed cases with family history positive for ARVC have a higher risk of developing arrhythmias. [hrcak.srce.hr]

  First described in 1992, the syndrome is identified by a distinctive ECG pattern consisting of right bundle-branch block and coved ST-segment elevation in the anterior precordial leads (V 1 through V 3 ). [web.archive.org]

• Incomplete Right Bundle Branch Block

  TAD = terminal activation duration, IRBBB = incomplete right bundle branch block, CRBBB = complete right bundle branch block. Undiagnosed cases with family history positive for ARVC have a higher risk of developing arrhythmias. [hrcak.srce.hr]

• T Wave Inversion

  […] with no history of CAD, and frequent T-wave inversion. [aafp.org]

  Prevalence of T-wave inversion beyond V1 in young normal individuals and usefulness for the diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia. Am J Cardiol. 2005 May 1. 95(9):1070-1. [Medline]. Leclercq JF, Coumel P. [emedicine.medscape.com]

  wave inversion, abnormal Q waves Laboratory: slightly ↑ troponin T;, ↑ BNP Echocardiography: apical left ventricular ballooning, ↓ LVEF Coronary angiography: usually no pathological findings (e.g., no obstruction of coronaries by plaque rupture); a minority [amboss.com]

  New electrocardiographic abnormalities either ST-segment elevation and/or T-wave inversion or modest elevation in cardiac troponin level. Absence of pheochromocytoma or myocarditis. [radiologyassistant.nl]

• Myocardial Fibrosis

  KEYWORDS: diabetic cardiomyopathy; heart failure; inflammation; metabolic dysregulation; myocardial fibrosis [ncbi.nlm.nih.gov]

  Myocardial fibrosis correlated with systolic function, and patients with poor outcomes had more extensive myocardial fibrosis. [jamanetwork.com]

  Because localizing focal fibrosis with LGE involves "nulling" the signal of surrounding myocardium, the technique is unable to identify more diffuse interstitial myocardial fibrosis. [emedicine.com]

  fibrosis Role in prognosis Differential diagnosis Nuclear imaging Endomyocardial biopsy Laboratory tests Genetic testing and family screening Counselling in probands Methods for molecular genetic screening in probands Indications for genetic testing [escardio.org]

• Left Ventricular Hypertrophy

  The changes of right ventricular hypertrophy are masked by left ventricular dominance; however, this patient had four-chamber dilatation on echocardiography. [lifeinthefastlane.com]

  A Patient Page on heart failure was published in the February 6, 2002, issue; one on left ventricular hypertrophy was published in the November 17, 2004, issue; one on risk factors for heart disease was published in the August 20, 2003, issue; and one [jamanetwork.com]

  This case presentation describes a 25-year-old man with post-mortem finding of previously unknown left ventricular hypertrophy. Genetic analysis revealed a mutation in the myosin-binding protein C (MYBPC3). [pure.au.dk]

  HCM is also harder to diagnose in athletes because it is similar to a harmless condition called left ventricular hypertrophy, where the left ventricle of the heart gets larger because of physical conditioning. [texasheart.org]

• Biventricular Hypertrophy

  The most common ECG abnormalities are those associated with atrial and ventricular hypertrophy — typically, left sided changes are seen but there may be signs of biatrial or biventricular hypertrophy. Interventricular conduction delays (eg. [lifeinthefastlane.com]

• Pleural Effusion

  Associated pleural effusions may also be seen. [radiopaedia.org]

  Pleural effusions may occur when fluid also accumulates in the pleural cavity. Edema may also be found in the cornea of the eye with glaucoma, severe conjunctivitis or keratitis or after surgery. [en.wikipedia.org]

  Pulmonary multi-detector computed tomography angiography excluded acute pulmonary embolism but revealed bilateral pulmonary infiltration and pleural effusion suggesting acute pulmonary edema. transthoracic echo-cardiography (TTE) revealed four-chamber [scielo.mec.pt]

  Some patients will also have pleural effusions detected by decreased breath sounds at the bases and dullness to percussion. Women with cardiomyopathy not due to a viral cause will be afebrile. [clinicaladvisor.com]

  Common abnormalities seen on the chest radiograph include cardiomegaly, interstitial edema, pleural effusion(s), and evidence of previous sternotomy (sternal wires). [clevelandclinicmeded.com]

For restrictive cardiomyopathy, therapeutic modalities are focused on the alleviation of the symptoms. Water and salt intake monitoring is paramount to prevent overload. In some case, patients are given diuretics to unload water retention in RCM. When heart failure become progressively worse, cardiac transplant may be the only option for RCM.

Dilated cardiomyopathy are medically treated with Angiotensin converting enzyme inhibitors, Angiotensin receptor blockers, beta blockers, digoxin, and diuretics [10]. A pacemaker may be installed in patients with DCM to synchronize any irregular cardiac rhythm. Hypertrophic cardiomyopathy are given medications to relax the heart muscles like beta blockers and calcium channel blockers. Cardiac surgeries like septal myectomy and septal ablation are some of the surgical options elected to debulk the thickened muscles of the heart.

In both children and adult population the outlook for restrictive cardiomyopathy is generally poor. Most patient progress to low output heart failure which may complicate to thromboembolism or cardiac cirrhosis. There is a higher mortality rate in dilated cardiomyopathy associated with severe congestive heart failure (CHF), male sex, and increasing age. About half of the patients with DCM presenting with CHF will die within the first 5 years from diagnosis [5]. Although patients with DCM having mild CHF carries a brighter outlook. Hypertrophic cardiomyopathy carries the best prognosis with only 1-3% mortality rating [6]. Majority of the mortality seen in HCM is due to sudden death caused by ventricular tachycardia and fibrillation. Morbidity and mortality improves with early diagnosis and intervention of the HCM disease [7].

In the majority of cases of cardiomyopathy, the etiologic causation is often times unknown. The following pre-morbid causes has been implicated as the most common identifiable causes of cardiomyopathy in clinical practice:

• Heart tissue scarring from a previous ischemia
• Long standing and uncontrolled hypertension
• Valvular Heart Diseases
• Chronic Tachyarrhythmias
• Thyroid diseases
• Diabetes mellitus
• Thiamine (Vitamin B1) deficiency
• Chronic alcoholism
• Pregnancy uteri
• Illicit drug use (cocaine, methamphetamine, anabolic steroids)
• Chemotherapeutic agents for cancer
• Viral infections
• Hemochromatosis
• Genetic heart diseases

In the world wide scale, the reported incidence of cardiomyopathy is up to 400,000 to 550,000 diagnosed cases per annum prevailing in up to 5 million people. In the United States, the most common form of restrictive myocarditis is the idiopathic type. The prevalence of endomyocardial fibrosis (EMF) abounds in the subtropical areas of Africa among children and young adults [1]. Causing 25% of the deaths due to heart diseases in the same African regions.

Dilated cardiomyopathy can affect patients at any age but symptoms usually surface in the third and fourth decade of life. Hypertrophic cardiomyopathy (HCM) represents 0.5% of patient brought in for diagnostic echocardiography [2]. The worldwide prevalence rate of HCM is only 50 to 200 cases per 100,000 population [3]. HCM has a slight male predilection over the female population with a peak mean age of occurrence at the third decade of life. Although in the adult population, the majority of the diagnosed cases HCM are within the 30’s to 60’s age range.

In restrictive cardiomyopathy (RCM), the stiffness in the myocardium can give rise to an increased intra ventricular pressure even in the light of a smaller stroke volume [4]. The restrictive effect on the ventricular volume can lead to diastolic heart failure because of the progressive loss of stroke volume due to the muscular restriction. Fibrotic changes in the heart muscles can cause cardiac scarring on the heart surface and cause bundle branch block in the electrophysiology of the heart.

In the dilated cardiomyopathy cases, the ventricle begins to enlarge due to the chronic left ventricular failure causing both systolic and diastolic type of heart failures. The progressive stretch of the heart’s myocardium reduces the volume of the cardiac output contributing to the development of congestive heart failure. The progressive dilatation of the ventricles can lead to the development of an acquired tricuspid and mitral valve regurgitation defects.

The progressive hypertrophy of the heart muscles in hypertrophic cardiomyopathy increases the pressure gradient in the outflow tracts of the circulating blood. Mitral valve dysfunction happens in hypertrophic cardiomyopathy when the hypertrophy involves the heart papillary muscles and the muscular septal hypertrophy displacing the outflow tract of the mitral valve. The thickening of the heart muscles can also impair the calcium channel physiology.

In most cases, cardiomyopathy could not be prevented. Patients can only modify some activities that may result in heart failure with cardiomyopathy like abstaining from alcohol or recreational drugs. A balanced diet with adequate vitamins and minerals can actively prevent heart failure in some cases of cardiomyopathies.

Cardiomyopathy is a general term given to abnormal heart muscles. Clinically, there are basically three types of cardiomyopathies: Restrictive, Dilated, and Hypertrophic cardiomyopathy. This abnormalities seen in the heart muscles retards the normal delivery of blood throughout the organ systems of the body. Cardiomyopathy can progress to serious heart failure if left untreated. Treatment approaches to cardiomyopathy grossly depends on the type and could be therapeutically corrected by either surgical or medical means.

• Definition: Cardiomyopathy refers to any clinical disease that involves the muscles of the heart that results in the alteration in the shape and size of the myocardium.
• Cause: A number of pre-morbid causes can give rise to cardiomyopathy like hypertension, thyroid diseases, diabetes, cardiac scarring, and viral infections.
• Symptoms: Patients with cardiomyopathy will typically present with dyspnea, orthopnea, paroxysmal nocturnal dyspnea, bilateral edema, and fatigue.
• Diagnosis: Cardiomyopathy work up includes: Chest X-ray, ECG, MRI, Echocardiography, blood tests, and cardiac catheterizations.
• Treatment and follow-up: Medical treatment of cardiomyopathy includes the usage of beta blocker, digoxin, ACE inhibitors, and calcium channel blockers. Surgical cardiac muscle myectomy and ablation may also be used to debulk the heart. 

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