Ischaemic Cardiomyopathy

20th May 2021

Ischaemic cardiomyopathy is a type of dilated cardiomyopathy.

In ischaemic cardiomyopathy, the heart’s ability to pump is reduced as the main pumping chamber of the heart becomes enlarged, dilated and weaker. 

This is caused by ischaemia- a reduced blood supply to the heart muscle, caused by narrowing of the heart arteries that supply the heart muscle with blood (coronary arteries). 

The narrowing of the coronary arteries is caused by fatty substances which build up over time. This is referred to as coronary artery disease and can sometimes lead to a heart attack. 
 
Some people who have ischaemic cardiomyopathy may experience some of the following symptoms:

  •  Shortness of breath 
  • Swelling of the feet and legs or tummy 
  • Fatigue- feeling overly tired
  • Angina- chest pain or a feeling of pressure which may be felt in the chest, neck, jaw, back or arms which occurs during exercise or sometimes at rest. 
  • Increase in weight due to fluid retention 
  • Palpitations or fluttering felt in the chest due to abnormal heart rhythms 
  • Dizziness or light-headedness or sometimes feeling faint 

Coronary artery disease can be caused by certain risk factors. These can include a family history of heart disease, high blood pressure, smoking, diabetes, high blood cholesterol and obesity. These can increase a person’s risk of developing cardiovascular disease and ischaemic cardiomyopathy. 

Ischaemic cardiomyopathy is diagnosed based on your medical history including your family history and investigations which may include:

  • An electrocardiogram (ECG- tracing of your heart’s electrical activity)
  • An echocardiogram (Echo- a scan which looks at the structure and function of your heart)
  • A chest x-ray, exercise stress test (an ECG whilst you are exercising on a treadmill or bike,)
  • A cardiac catheterisation (a procedure to look at the heart arteries/ coronary arteries)
  • A CT scan ( detailed x-ray images of the body)
  • A Cardiac MRI scan (a specialised  investigation to look closely at the structure and function of the heart). 

Treatment of ischaemic cardiomyopathy is aimed at treating coronary artery disease and improving the pumping function of the heart and reducing symptoms.

This is usually with medications which may include beta blockers and ACE inhibitors. Some people may be advised to take diuretic medications which help to reduce fluid build-up in the body these can help to reduce ankle swelling and shortness of breath. Other medications will be advised as needed. View our information on medication here 

Treatment of coronary artery disease may sometimes be advised depending on symptoms. This may be by:

  • Coronary angioplasty (a procedure which opens up the narrowed coronary artery using a balloon device)
  • Coronary stenting (a procedure where a small wire mesh tube is inserted into the narrowed coronary artery) 
  • Coronary artery bypass grafting (a surgical procedure where a blood vessel is used to ‘bypass’ (go around) the narrowed coronary artery)

You may be advised to have a device implanted. This might be an Implantable Cardioverter Defibrillator (ICD) or a Cardiac Resynchronisation Therapy (CRT) device. An ICD monitors the rhythm of the heart and corrects any abnormal fast heart rhythms with energy (a shock) to restore the heart rhythm back to normal.

A CRT device senses and produces heartbeats in the right and left sides of the lower chamber of the heart ( ventricle) this helps the heart to pump in a more synchronised pattern (at the same time) and can help to reduce symptoms and increase heart function. 
 
You may be given advice about lifestyle changes you can make which may include: 

Diet
Exercise you may be referred for cardiac rehabilitation for advice about exercise. 
Smoking

Nurse Jayne Partridge, 2021.