Cardiomyopathy: A Guide for Primary Care.

Cardiomyopathy is a condition in which the myocardium is diseased, resulting in structural and functional abnormalities. This review focuses on nonischemic causes for cardiomyopathies. The overall presentation can vary in severity and age at symptom onset depending on the underlying cause. Symptoms depend on the type of cardiomyopathy but often include dyspnea, fatigue, arrhythmia, and syncope. Cardiomyopathies can be classified as primary (related to conditions isolated to the heart) or secondary (related to systemic disease such as amyloidosis). The most common primary cardiomyopathy is hypertrophic cardiomyopathy. Evaluation of cardiomyopathy includes a detailed personal and family history in conjunction with a physical examination. Further assessment includes electrocardiography, echocardiography, or other advanced imaging modalities. Management is guided by the type of cardiomyopathy and includes guideline-directed medical therapy for heart failure, rate or rhythm control for arrhythmias, anticoagulation for those at risk for coagulopathy, and risk-stratified counseling for physical activity. Risk stratification for an implantable cardioverter-defibrillator is recommended in all patients with hypertrophic cardiomyopathy. Heart transplantation can be considered for those with advanced disease.