Cardiomyopathy refers to a group of diseases affecting the heart muscle, resulting in structural and functional abnormalities that impair the heart’s ability to pump blood effectively. Unlike coronary artery disease, which primarily affects the blood vessels, cardiomyopathy directly involves the myocardium (heart muscle) and can lead to heart failure, arrhythmias, thromboembolic events, and sudden cardiac death if left untreated.

Cardiomyopathy is broadly classified into several types based on structural and functional characteristics. Dilated cardiomyopathy is the most common form and is characterized by enlargement and weakening of the ventricles, leading to reduced ejection fraction and systolic heart failure. Hypertrophic cardiomyopathy involves abnormal thickening of the heart muscle, often genetic in origin, which can obstruct blood flow and predispose patients to dangerous arrhythmias. Restrictive cardiomyopathy is marked by stiff ventricular walls that impair filling during diastole, while arrhythmogenic cardiomyopathy affects the heart’s electrical stability and increases the risk of sudden cardiac arrest.

Causes of cardiomyopathy are diverse and include genetic mutations, long-standing hypertension, ischemic heart disease, viral infections (myocarditis), excessive alcohol consumption, certain chemotherapy agents, metabolic disorders, autoimmune diseases, and pregnancy-related changes. In some cases, the cause remains idiopathic despite extensive evaluation.

Patients with cardiomyopathy may present with symptoms such as progressive shortness of breath, fatigue, reduced exercise tolerance, chest discomfort, palpitations, dizziness, syncope, or swelling of the legs and abdomen due to fluid retention. Symptoms may develop gradually or present suddenly, particularly in advanced disease or arrhythmogenic forms.

Diagnosis requires a comprehensive cardiac evaluation. This includes electrocardiography (ECG), echocardiography to assess chamber size and ventricular function, cardiac MRI for tissue characterization, blood tests, genetic testing when indicated, and sometimes coronary angiography to exclude ischemic causes. Risk stratification for arrhythmias and sudden cardiac death is a critical component of assessment.

Management of cardiomyopathy is tailored to the specific subtype and severity. Treatment focuses on improving cardiac function, controlling symptoms, preventing disease progression, and reducing the risk of complications. This may include guideline-directed medical therapy for heart failure, rhythm control strategies, anticoagulation when indicated, and device-based therapies such as implantable cardioverter-defibrillators (ICDs) or cardiac resynchronization therapy (CRT). Lifestyle modification and long-term follow-up are essential components of care.

With early diagnosis, appropriate therapy, and regular monitoring, many patients with cardiomyopathy can achieve symptom control, improved quality of life, and reduced risk of adverse cardiac events.