Cardiomyopathy

What you need to know

Breathe easier and return your heart to better health by dealing with the damage caused by cardiomyopathy. According to research or other evidence, the following self-care steps may be helpful:

See a specialist
Consult a cardiologist for advice on treating your type of cardiomyopathy and its underlying causes

Count on co-Enzyme Q10
At mealtimes, take 100 to 150 mg a day of this powerful anti-oxidant to improve quality of life, heart function, and survival rates

Get help from hawthorn
Relieve heart failure symptoms associated with cardiomyopathy by taking 160 to 900 mg a day of a standardised extract of this heart-healthy herb

Kick the habits
Prevent cardiomyopathy and its complications by limiting or giving up alcohol and ending your addiction to cigarettes

Discover arjun
Improve heart function by taking 500 mg of a concentrated extract of this herb three times a day

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or chemist. Continue reading the full cardiomyopathy article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About cardiomyopathy

Cardiomyopathy refers to abnormalities in the structure or function of the heart muscle. There are three major types of cardiomyopathy: dilated congestive, hypertrophic, and restrictive.

The most prevalent form is dilated congestive cardiomyopathy (DCM). In people with DCM, the heart muscle is damaged, most commonly by coronary artery disease (atherosclerosis).¹ People with diabetes have been reported to be at increased risk of DCM.² DCM can also be triggered by alcohol abuse, infections, exposure to certain drugs and toxins, nutritional deficiencies, connective tissue diseases, hereditary disorders, and pregnancy.

In DCM, the heart gradually loses its efficiency as a pump. Cardiomyopathy is a serious health condition and requires expert medical care rather than self-treatment. However, because of the associations between cardiomyopathy and diseases such as atherosclerosis, diabetes, hypertension, and congestive heart failure, lifestyle recommendations for the prevention of these conditions may also help prevent DCM.

Hypertrophic cardiomyopathy is usually a hereditary disorder, although the incidence of this form of cardiomyopathy may also be higher in people with hypertension.³ Restrictive cardiomyopathy is usually due to a connective tissue disease, cancer, or an auto-immune condition. Both hypertrophic and restrictive cardiomyopathies are relatively uncommon.

Product ratings for cardiomyopathy

Rating	Nutritional Supplements	Herbs
	Co-Enzyme Q10	Arjun Hawthorn (if congestive heart failure is also present)
	L-carnitine (only for children with inherited cardiomyopathy) Selenium (only for Keshan’s cardiomyopathy) Taurine Vitamin B1 (Thiamine) (only for wet beri beri)	Coleus Dan shen Hawthorn (if congestive heart failure is not present)
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

People with cardiomyopathy may have difficulty breathing during light exertion, and they may become fatigued easily. Other chronic symptoms are swelling around the ankles and an enlarged abdomen.

Dietary changes that may be helpful

Protein-calorie malnutrition (PCM) may cause cardiomyopathy, though PCM is rare in U.S. society.

Lifestyle changes that may be helpful

Cardiomyopathy occurs with greater frequency in people who drink to excess.⁴ Alcoholics are at significantly greater risk of developing a deficiency of thiamine (vitamin B1).⁵ ⁶ They also may develop a form of thiamine deficiency called wet beri beri or Shoshin beri beri, which frequently includes cardiomyopathy.⁷ ⁸ See “Nutritional supplements that may be helpful,” below, for more information.

Among alcoholics, the risk of developing DCM is greater for women than for men.⁹ Many doctors suggest that people with cardiomyopathy abstain from alcohol consumption. People with alcohol-induced cardiomyopathy who avoid alcohol may regain their health.

Moderate to heavy physical activity can be life-threatening for people with cardiomyopathy;¹⁰ however, appropriate exercise often improves the condition.¹¹ ¹² ¹³ ¹⁴ How much is “too much” varies from person to person. Any exercise programme undertaken by someone with cardiomyopathy requires professional supervision.

The risk of being diagnosed with cardiomyopathy goes up with the number of cigarettes smoked per day.¹⁵ ¹⁶ However, a few studies have reported a paradoxical decrease in the death rate among smokers with DCM compared with nonsmokers who have this disease.¹⁷ ¹⁸ While the meaning of this association remains unclear, virtually all doctors recommend that smokers with DCM quit smoking for a wide variety of health-related reasons.

Other therapies

Severe cases might require heart transplantation surgery.

Vitamins that may be helpful

People with DCM have been shown to be deficient in co-Enzyme Q10.¹⁹ Most studies using co-Enzyme Q10 in the treatment of cardiomyopathy have demonstrated positive results, including improved quality of life, heart function tests, and survival rates.²⁰ ²¹ ²² Co-Enzyme Q10 also has been shown to improve cardiac function in people with hypertrophic cardiomyopathy—a less common form of cardiomyopathy.²³ A few studies, however, have found no benefit from CoQ10 supplementation in treating people with cardiomyopathy.²⁴ ²⁵ Despite a lack of consistency in the outcomes of published research, many doctors recommend that 100 to 150 mg be taken each day, with meals.

Deficiency of L-carnitine, an amino acid, is associated with the development of some forms of cardiomyopathy.²⁶ Inherited forms of cardiomyopathy seen in children may be the most responsive to therapy with L-carnitine.²⁷ ²⁸ Whether carnitine supplementation helps the average person with cardiomyopathy remains unknown. Nonetheless, some doctors recommend 1 to 3 grams of carnitine per day for adults of average weight.

A few veterinary studies have demonstrated benefits from supplementation with taurine, another amino acid, in animals with cardiomyopathy. Most of these studies showed taurine deficiency to be a cause of cardiomyopathy. Taurine supplementation in animals with DCM has resulted in improvement of symptoms and survival rates.²⁹ ³⁰ However, clinical studies in humans are lacking; thus, despite a good safety record, the benefits of taurine supplementation in people with any form of cardiomyopathy remain speculative. When taurine supplements are used by doctors to treat people with other conditions, 2 grams taken three times per day for a total of 6 grams per day is often recommended.

Selenium deficiency has occasionally been reported as a cause of cardiomyopathy.³¹ ³² Selenium deficiency is the probable cause of Keshan’s disease, a form of cardiomyopathy found in China³³ ³⁴ but only rarely reported in the United States.³⁵ Studies comparing populations in parts of the world other than mainland China have not supported a link between selenium deficiency and DCM,³⁶ ³⁷ except in Taiwan.³⁸ Moreover, no clinical trials outside of China have explored the effects of supplementation with selenium for people with DCM, nor is there reason to believe that selenium supplementation would help most people outside of China and Taiwan suffering from cardiomyopathy.

The small proportion of people with cardiomyopathy whose disease is due to severe vitamin B1 (thiamine) deficiency (known as wet beri beri) generally require intravenous vitamin B1, followed by oral supplementation. Vitamin B1 does not appear to be helpful for other types of cardiomyopathy. People requiring vitamin B1 for cardiomyopathy must first be diagnosed as having wet beri beri, and treatment must be supervised by a healthcare professional.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

Many doctors expert in herbal medicine consider hawthorn to be an effective and low-risk therapy for congestive heart failure, the main complication of cardiomyopathy. Rigorous clinical trials have now confirmed the effectiveness of hawthorn for the signs and symptoms of early-stage congestive heart failure,³⁹ ⁴⁰ ⁴¹ though hawthorn studies with cardiomyopathy patients have yet to be conducted. The clinical trials with heart-failure patients have demonstrated efficacy using 80 to 300 mg of standardised extract of hawthorn leaves and flowers two to three times per day.

Two herbs used in the traditional medicine of India (Ayurveda) to treat people with cardiomyopathy and congestive heart failure have recently been supported by a small amount of clinical research. Arjun (Terminalia arjuna) has been shown to significantly improve the signs and symptoms of cardiomyopathy, as well as the objective measurements of heart function.⁴² In a clinical trial, people with DCM and severe heart failure took 500 mg of arjun extract three times daily. After two weeks, significant improvement in heart function was observed, an effect that continued over the course of approximately two years.⁴³ The arjun used in this study was concentrated, but not standardised for any particular constituent. Commercial preparations are sometimes standardised to contain 1% arjunolic acid.

Another Ayurvedic herb, coleus, contains forskolin, a substance that may help dilate blood vessels and improve the forcefulness with which the heart pumps blood.⁴⁴ Recent clinical studies indicate that forskolin improves heart function in people with cardiomyopathy and congestive heart failure.⁴⁵ ⁴⁶ A preliminary trial found that forskolin reduced blood pressure and improved heart function in people with cardiomyopathy. These trials used intravenous injections of isolated forskolin. It is unknown whether oral coleus extracts would have the same effect. While many doctors and practitioners of herbal medicine would recommend 200 to 600 mg per day of a coleus extract containing 10% forskolin, these amounts are extrapolations and have yet to be confirmed by direct clinical research.

Dan shen (Salvia miltiorrhiza), a Chinese herb, has been traditionally used to treat angina and coronary artery disease. Some studies suggest that dan shen may improve the force of heart contractions and coronary circulation, and may prevent damage to the heart muscle that might lead to cardiomyopathy.⁴⁷ ⁴⁸ ⁴⁹ However, no clinical trials of dan shen for DCM have been reported. Doctors expert in Chinese herbal medicine typically recommend 1 to 6 grams per day of dried root.

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

References

1. Beers MH and Berkow R, eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck and Co., Inc., 1999, 1692.

2. Coughlin SS, Pearle DL, Baughman KL, et al. Diabetes mellitus and risk of idiopathic dilated cardiomyopathy. The Washington, DC Dilated Cardiomyopathy Study. Ann Epidemiol 1994;4(1):67–74.

3. Post WS, Larson MG, Levy D. Hemodynamic predictors of incident hypertension. The Framingham Heart Study. Hypertension 1994;24(5):585–90.

4. McKenna CJ, Codd MB, McCann HA, Sugrue DD. Alcohol consumption and idiopathic dilated cardiomyopathy: a case control study. Am Heart J 1998;135(5 Pt 1):833–7.

5. Hoyumpa AM. Mechanisms of vitamin deficiencies in alcoholism. Alcohol Clin Exp Res 1986;10(6):573–81.

6. Lieber CS. Alcohol-nutrition interaction: 1984 update. Alcohol 1984;1(2):151–7.

7. Klatsky AL. The cardiovascular effects of alcohol. Alcohol 1987;Suppl 1:117–24.

8. Friedman HS. Cardiovascular effects of alcohol with particular reference to the heart. Alcohol 1984;1(4):333–9.

9. Urbano-Marquez A, Estruch R, Fernandez-Sola J, et al. The greater risk of alcoholic cardiomyopathy and myopathy in women compared with men. JAMA 1995;274(2):149–54.

10. Valgaeren G, Conraads V, Colpaert C, et al. Sudden death in hypertrophic cardiomyopathy: risk stratification and prevention. Acta Cardiol 1998;53(1):23–9.

11. Belardinelli R, Georgiou D, Cianci G, et al. Effects of exercise training on left ventricular filling at rest and during exercise in patients with ischemic cardiomyopathy and severe left ventricular systolic dysfunction. Am Heart J 1996;132(1 Pt 1):61–70.

12. Belardinelli R, Georgiou D, Cianci G, et al. Exercise training improves left ventricular diastolic filling in patients with dilated cardiomyopathy. Clinical and prognostic implications. Circulation 1995;91(11):2775–84.

13. Wielenga RP, Erdman RA, Huisveld IA, et al. Effect of exercise training on quality of life in patients with chronic heart failure. J Psychosom Res 1998;45(5):459–64.

14. Hambrecht R, Fiehn E, Weigl C, et al. Regular physical exercise corrects endothelial dysfunction and improves exercise capacity in patients with chronic heart failure. Circulation 1998;98(24):2709–15.

15. Coughlin SS, Neaton JD, Sengupta A, Kuller LH. Predictors of mortality from idiopathic dilated cardiomyopathy in 356,222 men screened for the Multiple Risk Factor Intervention Trial. Am J Epidemiol 1994;139(2):166–72.

16. Hartz AJ, Ratner ER, Sinoway LI, Bartholomew MJ. Smoking and idiopathic congestive cardiomyopathy. Jpn Heart J 1996;37(3):401–7.

17. Juilliere Y, Danchin N, Briancon S, et al. Dilated cardiomyopathy: long-term follow-up and predictors of survival. Int J Cardiol 1988;21(3):269–77.

18. Metayer C, Coughlin SS, Mather FJ. Does cigarette smoking paradoxically increase survival in idiopathic dilated cardiomyopathy? The Washington, D.C., Dilated Cardiomyopathy Study. Cardiology 1996;87(6):502–8.

19. Manzoli U, Rossi E, Littarru GP, et al. Coenzyme Q10 in dilated cardiomyopathy. Int J Tissue React 1990;12(3):173–8.

20. Pogessi L, Galanti G, Comeglio M, et al. Effect of coenzyme Q10 on left ventricular function in patients with dilative cardiomyopathy. Curr Ther Res 1991;49:878–86.

21. Langsjoen PH, Vadhanavikit S, Folkers K. Response of patients in classes III and IV of cardiomyopathy to therapy in a blind and crossover trial with coenzyme Q10. Proc Natl Acad Sci U S A 1985;82:4240–4.

22. Ma A, Zhang W, Liu Z. Effect of protection and repair of injury of mitochondrial membrane-phospholipid on prognosis in patients with dilated cardiomyopathy. Blood Press Suppl 1996;3:53–5.

23. Belardinelli R, Georgiou D, Cianci G, et al. Effects of exercise training on left ventricular filling at rest and during exercise in patients with ischemic cardiomyopathy and severe left ventricular systolic dysfunction. Am Heart J 1996;132(1 Pt 1):61–70.

24. Bresolin N, Doriguzzi C, Ponzetto C, et al. Ubidecarenone in the treatment of mitochondrial myopathies: a multi-center double-blind trial. J Neurol Sci 1990;100:70–8.

25. Permanetter B, Rossey W, Weingartner F, et al. Lack of effectiveness of coenzyme Q10 (Ubiquinone) in long-term treatment of dilated cardiomyopathy. Z Kardiol 1989;78:360–5 [in German].

26. Paulson DJ. Carnitine deficiency-induced cardiomyopathy. Mol Cell Biochem 1998;180(1–2):33–41.

27. Winter S, Jue K, Prochazka J, et al. The role of L-carnitine in pediatric cardiomyopathy. J Child Neurol 1995;10 Suppl 2:S45–51.

28. Kothari SS, Sharma M. L-carnitine in children with idiopathic dilated cardiomyopathy. Indian Heart J 1998;50:59–61.

29. Kittleson MD, Keene B, Pion PD, Loyer CG. Results of the multicenter spaniel trial (MUST): taurine- and carnitine-responsive dilated cardiomyopathy in American cocker spaniels with decreased plasma taurine concentration. J Vet Intern Med 1997;11:204–11.

30. Pion PD, Kittleson MD, Thomas WP, et al. Response of cats with dilated cardiomyopathy to taurine supplementation. J Am Vet Med Assoc 1992;201:275–84.

31. Auzepy P, Blondeau M, Richard C, et al. Serum selenium deficiency in myocardial infarction and congestive cardiomyopathy. Acta Cardiol 1987;42:161–6.

32. Oster O, Prellwitz W, Kasper W, Meinertz T. Congestive cardiomyopathy and the selenium content of serum. Clin Chim Acta 1983;29(128):125–32.

33. Xu GL, Wang SC, Gu BQ, et al. Further investigation on the role of selenium deficiency in the aetiology and pathogenesis of Keshan disease. Biomed Environ Sci 1997;10:316–26.

34. Neve J. Selenium as a risk factor for cardiovascular diseases. J Cardiovasc Risk 1996;3:42–7.

35. Collipp PJ, Chen SY. Cardiomyopathy and selenium deficiency in a two-year-old girl. N Engl J Med 1981;304:1304–5 [letter].

36. Raines DA, Kinsara AJ, Eid Fawzy M, et al. Plasma and urinary selenium in Saudi Arabian patients with dilated cardiomyopathy. Biol Trace Elem Res 1999;69:59–68.

37. Ikram H, Crozier IG, Webster M, Low CJ. The role of selenium deficiency in occidental dilated cardiomyopathy. N Z Med J 1989;102:100–2.

38. Chou HT, Yang HL, Tsou SS,et al. Status of trace elements in patients with idiopathic dilated cardiomyopathy in central Taiwan. Chung Hua I Hsueh Tsa Chih (Taipei) 1998;61:193–8.

39. Weikl A, Assmus KD, Neukum-Schmidt A, et al. Crataegus Special Extract WS 1442. Assessment of objective effectiveness in patients with heart failure. Fortschr Med 1996;114:291–6 [in German].

40. Weihmayr T, Ernst E. Therapeutic effectiveness of Crataegus. Fortschr Med 1996;114:27–9 [in German].

41. Leuchtgens H. Crataegus Special Extract WS 1442 in NYHA II heart failure. A placebo controlled randomized double-blind study. Fortschr Med 1993;111:352–4 [in German].

42. Dwivedi S, Jauhari R. Beneficial effects of Terminalia arjuna in coronary artery disease. Indian Heart J 1997;49:507–10.

43. Bharani A, Ganguly A, Bhargava KD. Salutary effect of Terminalia Arjuna in patients with severe refractory heart failure. Int J Cardiol 1995;49:191–9.

44. Lindner E, Dohadwalla AN, Bhattacharya BK. Positive inotropic and blood pressure lowering activity of a diterpene derivative isolated from Coleus forskohli: forskolin. Arzneimittelforschung 1978;28:284–9.

45. Baumann G, Felix S, Sattelberger U, Klein G. Cardiovascular effects of forskolin (HL 362) in patients with idiopathic congestive cardiomyopathy—a comparative study with dobutamine and sodium nitroprusside. J Cardiovasc Pharmacol 1990;16:93–100.

46. Kramer W, Thormann J, Kindler M, Schlepper M. Effects of forskolin on left ventricular function in dilated cardiomyopathy. Arzneimittelforschung 1987;37:364–7.

47. Takeo S, Tanonaka K, Hirai K, et al. Beneficial effect of tan-shen, an extract from the root of Salvia, on post-hypoxic recovery of cardiac contractile force. Biochem Pharmacol 1990 40:1137–43.

48. Bai YR, Wang SZ. Hemodynamic study on nitroglycerin compared with Salvia miltiorrhiza. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih 1994;14:24–5 [in Chinese].

49. Xing ZQ, Zeng XC, Yi CT. Effect of Salvia miltiorrhiza on serum lipid peroxide, superoxide dismutase of the patients with coronary heart disease. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih 1996;16:287–8 [in Chinese].

Learn more about Healthnotes, the company.

Learn more about the authors of Healthnotes.

The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or chemist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires September 2008.

2007-09-01