Treatments for Cardiomyopathy: An Integrative Approach

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Everyone knows about coronary artery disease, heart valve disease, hypertension, arrhythmias, and heart failure. Cardiomyopathy, however, might not be on your radar— even though it may be the cause or the consequence of these other cardiovascular conditions.

What Is Cardiomyopathy?

As its name suggests, cardiomyopathy is a heart (cardio) muscle (myo) disease (pathy). There are several types of cardiomyopathy, and they all affect the heart’s ability to pump blood:

  • Dilated: Dilated cardiomyopathy, which usually originates in the left ventricle (the main pumping chamber), causes the ventricle walls to thin and stretch out of shape, resulting in an enlarged and weakened heart.
  • Hypertrophic: In this type, the walls of the left ventricle become abnormally thick and stiff, making it harder for the heart to relax and fill with blood and thus reducing the amount of blood pumped out with each beat.
  • Other forms: These include arrhythmogenic, which affects heart rate and rhythm; restrictive, marked by scarred, rigid ventricles that cannot fill properly; and stress-induced cardiomyopathy, poignantly called broken heart syndrome because its onset often coincides with severe emotional stress.

Cardiomyopathy Causes

Cardiomyopathy is often caused by conditions like heart attacks, chronic hypertension, valve problems, or congenital heart disease that weaken the heart. Infections, drug or alcohol abuse, exposure to toxins including some cancer drugs, and a handful of conditions such as hemochromatosis (iron overload) are also linked with cardiomyopathy.

Predisposing genetic abnormalities have been identified as well. Hypertrophic cardiomyopathy, for example, has strong genetic underpinnings. When you hear about a healthy young person suddenly dying during an athletic event or other strenuous activity, the cause is often inherited hypertrophic cardiomyopathy.

In about a third of cases, however, cardiomyopathy is idiopathic, which is a scientific way of saying, “We don’t know what the heck caused it.”

Heart Muscle Disease Symptoms

Many people with mild cardiomyopathy live normal lives and may never even know they have it. For others, it is a progressive disease that goes unnoticed at first but becomes increasingly symptomatic over time.

The most common early symptoms are fatigue, shortness of breath, and edema (swelling and fluid buildup) in the feet, ankles, and legs. Some patients also develop heart murmurs, arrhythmias, or lightheadedness.

As the disease progresses, fatigue increases, even at rest. Edema worsens, and fluids collect in the abdomen and lungs, making breathing more difficult, especially when lying down. Arrhythmias may intensify, and dizziness and fainting might occur.

If these symptoms sound familiar, it’s because they are the classic signs of heart failure. Cardiomyopathy is a leading cause of heart failure, which takes a significant toll on quality of life and is a contributing factor in one in eight deaths in the US.

Diagnosing Cardiomyopathy

If you are experiencing any of these symptoms, you need to consult a doctor. Examination and workup for cardiomyopathy may include:

  • Medical/family history to consider potential causes and genetic predisposition.
  • Physical exam to check for swelling in the lower extremities and abdomen, heart murmur or arrhythmia, and sounds suggestive of fluid in the lungs.
  • Chest X-ray to look for enlargement of the heart and lung congestion.
  • Echocardiogram to evaluate heart function, size, shape, and ejection fraction, which measures how much blood your left ventricle pumps out with each contraction. (A reduced ejection fraction may be indicative of heart muscle disease.)
  • Electrocardiogram to record the heart’s electrical activity.
  • Exercise stress test to see how your heart performs during physical exertion.

Treatments for Cardiomyopathy

Heart medications to address symptoms and related conditions are first-line treatments. Recommended lifestyle changes include weight loss, salt and alcohol restriction, exercise, and stress management. An implanted defibrillator may be appropriate for severe symptoms due to refractory arrhythmias, and the most serious cases require heart transplantation.

All these therapies are well and good, and I have used them with my patients. However, an essential aspect of cardiomyopathy treatment is inexplicably overlooked. The constantly beating heart has exceptionally high energy requirements. Therefore, cardiac muscle cells contain an ultra-dense concentration of mitochondria—the “energy factories” in your cells where ATP, the fuel that drives cellular activities, is produced.

Mitochondrial function and biogenesis (the creation of new mitochondria) are often compromised in diseased heart muscle cells. As a result, energy demands outstrip energy supply, leaving patients with an energy deficit that contributes to symptoms and disease progression.

Top 4 Supplements for Cardiomyopathy

That’s why I like to take a metabolic cardiology approach to cardiomyopathy. This means using nutrients that help to replenish the body’s stores of crucial compounds that support and enhance mitochondrial function, boost ATP production, and re-energize the struggling heart.

To do that, I consider the following four supplements to be indispensable for patients with cardiomyopathy:

  • Coenzyme Q10: CoQ10 is essential for the production of ATP (your body’s fuel) in the mitochondria. CoQ10 levels decline precipitously in diseases of the heart muscle, and numerous studies support the therapeutic benefits of supplemental CoQ10. Suggested dose: 300–600 mg daily, taken in divided doses.
  • L-carnitine: This amino acid transports fatty acids (an important fuel for ATP production in cardiac cells) into the mitochondria. Like CoQ10, levels decline in diseased hearts, and supplemental L-carnitine provides multiple benefits. Suggested dose: 1,000–2,000 mg 1–2 times a day, preferably on an empty stomach.
  • D-ribose: A simple sugar that is required for ATP generation, D-ribose is rapidly depleted in heart muscle diseases. Restoring levels with supplemental D-ribose improves overall heart function. Suggested dose: 5 grams three times per day.
  • Magnesium: Magnesium is also vital for cellular energy metabolism. Low magnesium intake is extremely common, and supplementation supports virtually every aspect of cardiovascular health. Suggested dose: 400–800 mg per day of a broad-spectrum magnesium supplement, taken in divided doses. (Magnesium can cause loose stools, so build up gradually and back off if this occurs.)

How Well Does It Work? Here’s Georgia’s Story

I have been recommending this integrative approach for decades and have repeatedly seen how it reduces symptoms, slows progression, and dramatically improves quality of life. A note I received from Georgia H. provides a perfect example.

When Georgia was diagnosed with cardiomyopathy at age 50, she had significant arrhythmias and an ejection fraction of just 20%, suggestive of advanced disease. For 10 years she was treated with one heart medication after another.

Then she read my book The Sinatra Solution: Metabolic Cardiology and began taking the recommended supplements. Because she had serious adverse reactions to most medications, her cardiologist resignedly accepted her decision to stop all prescription drugs, and she agreed to an implanted defibrillator.

For the past 17 years—using only these supplements and no drugs—she has done very well. Now age 77, the last two years have been rough with two bouts of congestive heart failure, so after a satisfying career mentoring teachers and writing phonics programs, she has retired. She thanked me and said that although we have never met, through the metabolic cardiology approach which she read in my book, I have kept her alive for the past 17 years.

Does this integrative approach to cardiomyopathy work? Is it worth trying to get the word out to patients who won’t hear about it from conventional cardiologists? You bet it is!


Dr. Stephen Sinatra

Meet Dr. Stephen Sinatra

A true pioneer, Dr. Sinatra spent more than 40 years in clinical practice, including serving as an attending physician and chief of cardiology at Manchester Memorial Hospital, then going on to formulate his advanced line of heart health supplements. His integrative approach to heart health has changed the lives of hundreds of thousands.

More About Dr. Stephen Sinatra