In general, “heart disease” refers to any disease affecting the heart, including diseases of the heart muscle (cardiomyopathies), its valves (valvular heart disease), coronary arteries (ischemic heart disease), rhythm disturbances (arrhythmias), various other conditions present at birth (congenital heart disease), including those affecting the aorta (aortopathies).
However, terminology equates “cardiopathy” with “cardiomyopathy”, and all the other forms mentioned above are known by their specific names.
Thus, we can say that a “cardiopathy” or “cardiomyopathy” is a disease affecting the heart muscle. This muscle weakens and its contraction and relaxation properties (like any other muscle) are insufficient to fulfill its function, which is to pump blood to all the organs of the body.
What types are there?
The classification of cardiomyopathies can be established as follows:
(a) Hereditary cardiomyopathies:
These are those that originate from alterations in the genetic sequence of some proteins necessary for myocardial contraction or enzymes and other factors that participate in this process. The fact that they are “hereditary” implies a pattern of family inheritance for their transmission from generation to generation; but this does not mean that they are present at birth (not to be confused with the concept of “congenital”). They may take time to manifest themselves and may not show symptoms until adolescence or adulthood. There are people who are carriers of the genetic alteration but do not develop symptoms.
Some examples are: hypertrophic cardiomyopathy, noncompaction cardiomyopathy, arrhythmogenic cardiomyopathy, familial idiopathic dilated cardiomyopathy, and cardiomyopathy due to hereditary amyloidosis.
b) Acquired cardiomyopathies:
These are those in which the alteration that prevents effective contraction has a secondary (non-hereditary) cause, which the individual has contracted due to the presence of other conditions, which may be:
- Reversible: sustained tachycardia (tachycardiocardioparathy), alcohol intake (alcoholic cardiomyopathy), toxics, such as some cancer treatments, but also drugs of abuse or doping substances (toxic cardiomyopathy, anthracycline-induced cardiomyopathy), some deficiency states, such as vitamin B deficiency, or endocrinometabolic disorders (metabolic cardiomyopathy, diabetic cardiomyopathy).
- Irreversible: these are due to causes that generate damage to the myocardium that persists even if the cause is corrected. Most causes are due to cardiovascular risk factors and progress to forms called “secondary dilated cardiomyopathy”. The most frequent causes are: arterial hypertension, ischemic heart disease (people who have suffered myocardial infarction), chronic renal disease, deposit diseases (senile amyloidosis), viral infections (infectious cardiomyopathies).
Which individuals are most at risk of developing cardiomyopathy?
As mentioned in the previous section, some causes are hereditary, but the contribution of this form is small: less than 20% of cardiomyopathies are hereditary. The greatest percentage of cardiomyopathies are acquired forms and, within these, the most frequent are hypertensive cardiomyopathy and ischemic heart disease.
People with cardiovascular risk factors are the most predisposed to develop cardiomyopathy, especially as age advances and if they have several factors. Many people develop combined forms due to the coexistence of several risk factors (i.e. ischemic-hypertensive cardiomyopathy).
Can it be prevented?
Hereditary cardiomyopathies cannot be prevented; however, all those with an acquired cause are preventable. We should “not acquire” lifestyle habits that condition the presence of risk factors that predispose us to develop cardiomyopathy (hypertension, diabetes, dyslipidemia, smoking, sedentary lifestyle, obesity, stress, infections). This can be achieved with a healthy lifestyle (diet, physical activity, adequate rest, not smoking, maintaining an adequate weight) and with the administration of specific vaccination, when indicated.