Diagnosis of Cardiomyopathy

Reviewed by: HU Medical Review Board | Last reviewed: February 2024

Cardiomyopathy is a heart condition that affects the heart muscle. Depending on the type of cardiomyopathy, the heart muscle may thicken, stiffen, or become larger. These changes impact the heart’s ability to pump blood effectively.1

Early detection and accurate diagnosis play a crucial role in managing this type of heart disease. Symptoms of cardiomyopathy include:1

  • Shortness of breath
  • Fatigue
  • Dizziness
  • Chest pain

However, some people do not have any symptoms, making cardiomyopathy hard to diagnose. This is why knowing your family history and staying on top of your heart health is key.1

How is cardiomyopathy diagnosed?

Diagnosing cardiomyopathy is a multi-step process. It may combine noninvasive tests with more invasive procedures to provide a full view of the heart's condition.2

Because cardiomyopathy can be passed down through families, your doctor may choose to do genetic testing or screening. Genetic testing may be appropriate if one or more of the following is true:2,3

  • You currently live with other heart issues
  • Cardiomyopathy runs in your family
  • Any of your family members passed away suddenly with no explanation

Types of diagnostic tests and procedures

Healthcare professionals may use various tests and procedures to diagnose cardiomyopathy.2


An echocardiogram (an ultrasound of the heart) is the most common test used to diagnose cardiomyopathy. Echocardiograms use sound waves to create detailed images of the heart’s structure and see how well it is working.1-3

This type of ultrasound test looks at the size, shape, and function of the heart. It assesses the heart’s valves, chambers, and pumping efficiency. It helps to find abnormalities in the heart, such as an enlarged heart or weakened heart muscle.2,3

Chest X-ray

A chest X-ray can show whether the heart is enlarged. An enlarged heart is a common sign of cardiomyopathy.1,3

Electrocardiogram (ECG or EKG)

An ECG is a noninvasive test that records the electrical activity of the heart. With electrodes attached to the skin, it produces a visual representation of the heart’s rhythm. An ECG can detect abnormal rhythms known as arrhythmias.3

Cardiac magnetic resonance imaging (MRI)

A cardiac MRI provides a more in-depth look at the heart using magnetic fields and radio waves. This test creates detailed images of the heart muscle, including the valves and blood vessels. This test may be necessary if other tests were not conclusive.3

Blood tests

Doctors use blood tests to look for signs called biomarkers that can help them assess the level of stress on the heart. Elevated levels of these biomarkers may suggest heart muscle damage or strain. Blood tests also can check other things like kidney, thyroid, and liver function.2,3

Stress tests

Stress tests involve measuring the heart’s response to physical activity. Typically, this is done by monitoring a person’s heart rate, blood pressure, and breathing while they walk or run on a treadmill. The tests can also be done using medicine and alongside imaging tests of the heart. Stress tests can be very helpful in evaluating the heart’s capacity. They can identify any abnormalities that point to cardiomyopathy.2,3

Holter monitors

These are portable devices that record the heart’s electrical activity. They are typically worn for 24 hours or longer. They help capture irregular heart rhythms or other abnormalities that may come and go. Holter monitors are often used when other tests, like ECGs or echocardiograms, have been inconclusive.4

Diagnostic procedures for cardiomyopathy

Aside from the above diagnostic tests, the following procedures can be helpful in making a cardiomyopathy diagnosis.

Cardiac catheterization

This procedure involves threading a thin tube (catheter) through blood vessels in the arm, groin, or neck to the heart. Doctors can look at different aspects of the heart, such as pressure inside the heart and its function during this procedure. It is used to help diagnose many heart diseases.2,3,5

Coronary angiography

During a cardiac catheterization, contrast dye is injected into the catheter. This dye makes the coronary arteries and the heart’s chambers visible on X-ray imaging. It allows doctors to check blood flow to the heart muscle and whether there are blockages that may need further procedures or changes in medicines.2,3

Heart biopsy

A biopsy involves taking a small tissue sample from the heart muscle through a catheter. The tissue is then analyzed to identify infections, inflammatory conditions, or other issues that might contribute to cardiomyopathy.2,3

Early detection is crucial

If you or a loved one has symptoms such as chest pain, shortness of breath, or irregular heartbeats, get a thorough heart evaluation. Remember, early detection can make a big difference in treating cardiomyopathy and maintaining heart health.

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