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Ischemic Cardiomyopathy

- Summary
- About ischemic cardiomyopathy
- Signs and symptoms
- Diagnosis methods
- Treatment and prevention
- Questions for your doctor

Reviewed By:
Abdou Elhendy, MD, PhD, FACC, FAHA
Robert I. Hamby, M.D., FACC, FACP

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Treatment and prevention

Treatment for ischemic cardiomyopathy often begins with treating the underlying coronary artery disease and taking steps to relieve the burden on the heart. An important first step is to make healthy lifestyle changes, such as eating a heart-healthy diet and quitting smoking.

In conjunction with lifestyle improvements, the physician may also choose to use medications. Significant advances have been made in the treatment of ischemic cardiomyopathy with medications to manage symptoms and help the heart beat more effectively. Possible medications include:

Aspirin. Daily aspirin has been shown to reduce the risk of blood clots and lower the level of inflammation in the heart.
Beta blockers. These reduce the workload of the heart, help protect against abnormal rhythms (arrhythmias), and block a part of the adrenalin system.
ACE inhibitors. These tone down the adrenalin system, reduce the size of the heart, strengthen the heart muscle and lower blood pressure, thus reducing the workload on the heart.
Angiotensin II receptor blockers. These also tone down the adrenalin system, shrink the enlarged heart, strengthen the heart muscle and lower the blood pressure, thus reducing the workload on the heart. These are often used as alternatives to ACE inhibitors in patients who cannot tolerate ACE inhibitors.
Aldosterone blockers. These are used to dampen a part of the adrenalin system.
Inotropes. In selected instances, digoxin may be prescribed to strengthen the contractions on the heart, which has been shown to reduce hospitalizations for heart failure.
Anticoagulants. Coumadin is indicated to reduce the risk of embolism in patients who develop a thrombus within the heart and or atrial fibrillation. Both conditions are not uncommon in patients with ischemic cardiomyopathy.

An implantable cardioverter defibrillator (ICD) is indicated in patients who are considered at high risk of death due to severe ventricular arrhythmias, which may cause sudden cardiac death.

Cardiac resynchronization therapy (CRT) may also be recommended. In this therapy, a special pacemaker is implanted that simultaneously paces different segments of the left ventricle. This allows for more synchronous pumping that can increase the efficiency of the heart. These devices are sometimes recommended for patients who have an ejection fraction of 35 percent or less. They are frequently combined with an ICD.

A significant number of patients with ischemic cardiomyopathy may also benefit from therapies that reestablish blood flow to the heart. These procedures may include coronary angioplasty with or without either coronary stenting (a minimally invasive procedure), or bypass surgery (an invasive procedure). Whether these procedures can be done strongly depends on the condition of the patient and evaluation of the heart (muscles and coronary arteries). In very severe cases, heart transplantation is an option.