17145 Ischemic Cardiomyopathy

Overview

Ischemic cardiomyopathy is a condition in which the heart's pumping ability becomes weak because of reduced blood flow to the heart muscle. This reduced blood flow is usually caused by narrowed or blocked arteries (coronary artery disease). When the heart muscle doesn't get enough oxygen-rich blood, it can become damaged, stretched, or scarred, making it harder for the heart to pump blood effectively to the rest of the body.

Yes. Ischemic cardiomyopathy is one of the most common causes of heart failure worldwide. Heart failure affects millions of people, and in high-income countries, ischemic heart disease is a leading cause.

It most often affects older adults, particularly people with a history of coronary artery disease, heart attack, high blood pressure, or diabetes. Men tend to develop it earlier than women, but after menopause the risk for women rises. It can also affect people who have had a heart attack at a younger age.

Symptoms

Common symptoms

• Shortness of breath, especially when active or lying flat
• Fatigue or feeling unusually tired
• Swelling in the legs, ankles, or feet (oedema)
• Rapid or irregular heartbeat (palpitations)
• Persistent cough or wheezing
• Chest discomfort or pressure (angina)
• Dizziness or light-headedness

Symptoms in children

• Babies may have difficulty feeding, sweat during feeding, or breathe rapidly.
• Children may seem easily tired during play and have swelling in the legs.

Symptoms in older adults

• Fatigue, breathlessness, and swelling may be mistaken for normal ageing.
• Confusion or reduced alertness can happen when the heart pumps less effectively.

Causes

Main causes

• Narrowed or blocked coronary arteries due to atherosclerosis (fatty deposits and inflammation)
• A previous heart attack that left scar tissue
• Chronic reduced blood flow that weakens the heart muscle over time

Risk factors

• High blood pressure
• High cholesterol
• Smoking
• Diabetes
• Obesity or being overweight
• Being physically inactive
• A family history of early heart disease
• Age (risk increases with age)
• Chronic stress or depression

When to see a doctor

See a doctor urgently if:

• Chest pain or pressure that occurs with activity and goes away with rest – this should be assessed promptly
• Breathlessness that is getting worse, or waking at night gasping for breath
• Fainting or near-fainting episodes

Book a routine appointment if:

• If you have risk factors such as high blood pressure, diabetes, or high cholesterol and have not had a heart check in the past year
• Whenever you notice new tiredness, breathlessness, or ankle swelling

Diagnosis

Your doctor will ask about your symptoms, medical history, and family history. They will listen to your heart and lungs, and check for swelling in your legs. Based on this, they may arrange tests to see how well your heart is pumping and to look for narrowed arteries.

Tests that may be done

• Blood tests, including a test for B-type natriuretic peptide (BNP) or NT-proBNP, which can rise when the heart is under strain
• An electrocardiogram (ECG) to check the heart's electrical activity
• A chest X-ray to look at the size and shape of the heart and the lungs
• An echocardiogram (ultrasound of the heart) to measure the pumping function (ejection fraction)
• An exercise stress test or cardiac MRI, depending on your situation
• A coronary angiogram to look inside the coronary arteries

What to expect at your appointment

You may be referred to a cardiologist (heart specialist) for further assessment. Tests are usually painless, and you will be given clear instructions beforehand. The goal of the tests is to confirm the diagnosis and build a treatment plan that is right for you.

Treatment

Treatment for ischemic cardiomyopathy aims to improve blood flow to the heart, reduce the heart’s workload, manage symptoms, and prevent further damage. Your healthcare team will tailor your treatment to your specific needs. With good adherence to the plan, quality of life can improve significantly.

Self-care at home

• Stop smoking and avoid second-hand smoke
• Limit alcohol, or avoid it if your doctor advises
• Follow a healthy eating pattern, generally lower in salt
• Weigh yourself regularly and tell your doctor if you gain weight quickly
• Learn to manage stress with relaxation techniques or hobbies

Medical treatments

Various medicines are used to protect the heart and ease symptoms. These may include medicines to widen blood vessels, reduce fluid build-up, slow the heart rate, lower blood pressure, and prevent blood clots. Some medicines help the heart muscle pump more effectively. Your doctor will explain the purpose of each medicine, possible side effects, and how to take it. Always take medicines exactly as prescribed.

When is surgery considered?

If medicines are not enough, procedures may be considered. These include coronary angioplasty and stenting (opening blocked arteries with a small balloon and inserting a mesh tube), or coronary artery bypass surgery (creating a new route for blood using a healthy vessel from another part of the body). In more advanced cases, devices such as a pacemaker or an implantable defibrillator can help the heart maintain a normal rhythm. Your heart team will discuss the options with you.

Living with this condition

Living with ischemic cardiomyopathy means paying attention to your body and following your care plan. You can often stay active, but you should balance activity with rest. Learn your usual symptoms and know what to do if they change. Keep all follow-up appointments.

Lifestyle tips

• Take daily gentle exercise like walking or cycling; ask your doctor what is safe for you
• Monitor your weight and blood pressure at home if able
• Avoid heavy lifting or straining, as this puts pressure on the heart
• Make sure you get enough sleep and rest
• Get support from family, friends, or a support group

Diet and exercise

A heart-healthy diet includes plenty of vegetables, fruits, whole grains, and lean proteins, while limiting salt, saturated fats, and sugary drinks. Exercise, when done safely, can strengthen your heart and improve your energy. Ask your doctor or cardiac rehabilitation team for a personalised plan.

Mental health and emotional wellbeing

Living with a long-term heart condition can cause worry, anxiety, or low mood. It is normal to feel overwhelmed at times. Talking to your doctor about these feelings is important—your emotional health matters just as much as your physical health. Depression can make heart conditions worse if it is not addressed.

Prevention

You can lower your risk of ischemic cardiomyopathy by looking after your heart. This includes not smoking, eating a balanced diet, keeping physically active, maintaining a healthy weight, and controlling blood pressure, cholesterol, and diabetes. If you already have heart disease, these steps can prevent the condition from getting worse.

Vaccines

Keep your vaccinations up to date, including the flu vaccine and COVID-19 vaccine, as infections can put extra strain on your heart.

Screening programmes

If you have a family history of heart disease, talk to your doctor about regular heart checks. They may measure your blood pressure, cholesterol, and blood sugar to spot problems early.

Complications

If left untreated

• Progressive heart failure (worsening breathlessness and fatigue)
• Arrhythmias (irregular heart rhythms) that can be dangerous
• Blood clots that may lead to stroke or pulmonary embolism
• Sudden cardiac arrest (a medical emergency)

Long-term outlook

With early diagnosis and the right treatment, many people with ischemic cardiomyopathy live well for many years. Although the condition is serious, treatments have improved greatly. Your outlook depends on the extent of heart damage, your overall health, and your commitment to the care plan. Most people can continue to enjoy meaningful daily activities.

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