I read that George Michael’s cause of death has finally been confirmed. He had dilated cardiomyopathy. I have never heard of such a disease. What is it?

Cardiomyopathy literally means abnormality of the heart muscle. There are several types of cardio­myopathy, which include dilated cardiomyopathy, hypertrophic cardiomyopathy and restrictive cardiomyopathy.

But what causes cardiomyopathy? Do you just get it out of the blue?

Some people seem to get it out of the blue. More often than not, the cause of cardiomyopathy in a person is unknown.

However, sometimes – there is a cause, and this can include genetics, heart tissue damage from a previous heart attack, high blood pressure, rapid heart rate (tachycardia) that is present for a long time, heart valve problems, metabolic disorders like obesity, thyroid problems or diabetes, and too much alcohol over many years, as well as other nutritional deficiencies of essential vitamins or minerals like thiamine (vitamin B1).

Other possible causes include complications of pregnancy, drug abuse (cocaine, amphetamines or anabolic steroids), certain chemotherapy drugs and radiation used to treat cancer, certain infections which may injure the heart and trigger cardiomyopathy and iron buildup in heart muscles (haemochromatosis).

Different causes of cardiomyopathy will lead to the different types of cardiomyopathy.

George Michael died of dilated cardiomyopathy. What is this?

Dilated cardiomyopathy is the commonest type of cardiomyopa­thy. In this one, the left ventricle of the heart becomes enlarged (dilated). The chamber becomes large. But the heart muscle remains thin. As a result, the heart won’t be able to pump out blood effectively.

This type of cardiomyopathy is more often associated with men. Some causes include genetic, coronary heart disease, infection, drug usage, alcohol usage or chemotherapy.

It is very difficult to speculate which of these attributed to George Michael’s dilated cardiomyopathy.

What about the rest of the cardiomyopathy types?

In hypertrophic cardiomyopathy, the left ventricle muscle is thickened. (Note that in dilated cardiomyopathy, the muscle is not thickened, but stretched.)

This also makes it difficult for the heart to pump out blood. Most people have a family history of this, and this is one that can develop during childhood.

In restrictive cardiomyopathy, the heart muscle of the left ventricle is rigid and less elastic, but is not thickened or expanded like the two previous types. The heart cannot expand and fill with blood properly.

This one tends to affect older people. There can be no apparent cause for it. However, iron buildup in the heart muscle is one attributed cause.

The restrictive type is not as common as the other two.

There are other types of cardiomyopathy, but they are very rare.

How will I know if I have cardiomyopathy?

It can be difficult to differentiate it from other causes of heart failure.

So the symptoms will be like that of heart failure, such as:

• Breathlessness after exertion, or even at rest if the heart failure is advanced.

• Swelling of the legs, ankles and feet because there is back-pooling of the blood, which cannot be pumped out easily by the left ventricle.

• Bloating of the abdomen (due to the same reason as above).

• Coughing while lying down due to fluid buildup in your lungs.

• Fatigue and tiredness.

• Irregular heartbeats that feel rapid or fluttering.

• Chest pain.

• Dizziness, lightheadedness and fainting.

If I have cardiomyopathy, what can I do? Am I doomed to die then?

Not necessarily. The difficult thing about cardiomyopathy is that it can have no signs and symptoms when it is early. Then when you actually get signs or symptoms, it has progressed to a certain stage already.

If you have signs and symptoms of heart failure, you will be prescribed medications for these – such as medicines to remove excess fluid from your body.

If you have heart rhythm issues, you may be implanted with a device to control your heartbeat.

There are various types of heart surgery to deal with the abnormal heart muscle. The final option – when everything else has failed – is a heart transplant.


Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, e-mail starhealth@thestar.com.my. The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.