Cardiomyopathies are a group of conditions affecting the heart muscle itself, and are not necessarily alike in their composition. Cardiomyopathy is usually classified according to the type of functional impairment as dilated, hypertrophic, and restrictive. The distinction between functional categories is not absolute and there can be overlap.
One of the most common forms is hypertrophic cardiomyopathy (HCM). It's characterized by thickening of heart muscle, not secondary to hypertension or valvular heart disease. HCM runs in families and there are many different types of mutations. Although some people with HCM may be asymptomatic, serious complications can include sudden cardiac death from ventricular arrhythmias, heart failure, mitral regurgitation, and atrial fibrillation. Treatment for HCM may be necessary and can come in the form of medications, surgical procedures, or placement of a cardiac defibrillator.
Another common form is dilated (congestive) cardiomyopathy, or DCM. This is characterized by heart enlargement and heart muscle dysfunction. DCM can be caused by alcoholism, infectious virus (myocarditis), hypertension, peripartum (related to pregnancy), ischemic heart disease, or may be idiopathic, with no cause identified — about 30% of these may be familial.
The more rare form is restrictive cardiomyopathy, characterized by impaired diastolic function. Common causes are radiation, sarcoidosis, scleroderma, and myocardial fibrosis after open-heart surgery.
The primary questions to be asked of a proposed insured that presents with a history of cardiomyopathy are:
- Age and date of diagnosis?
- Type of cardiomyopathy and cause, if known?
- Any family history of sudden cardiac death?
- Current symptoms?....level of severity?
- How is the condition being treated?
- Results of recent cardiac testing?....Ejection Fraction?....ventricular thickness?
Underwriting decisions for cardiomyopathy can be challenging. The underwriter needs to assess the risk of sudden cardiac death, which is increased if there is a history of syncope, previous cardiac arrest or serious arrhythmias, a family history of sudden cardiac death, and/or significant thickening of the heart muscle. The information needed to be gathered can be found on the cardiomyopathy questionnaire.
Standard rates are usually a best-case scenario in the most ideal of cases. More typically, though, you’ll see ratings in the Table 2-6 range, or higher…and depending on the severity of the condition, and if in conjunction with other heart issues, may often be declined.Download the Questionnaire