Focus on cardiomyopathy

What is cardiomyopathy?

Cardiomyopathy is a medical condition characterized by abnormalities in the heart muscle. This condition can significantly impair the heart's ability to pump blood effectively, which in turn affects the delivery of oxygen and nutrients to various parts of the body. There are several primary types of cardiomyopathy, including dilated cardiomyopathy, hypertrophic cardiomyopathy, and restrictive cardiomyopathy. Each type has distinct features and implications for heart function. If left untreated, cardiomyopathy can progress to heart failure, a serious condition that requires immediate medical attention.

The signs and symptoms of cardiomyopathy

In the initial stages of cardiomyopathy, many individuals may not exhibit any noticeable signs or symptoms. However, as the condition progresses, various symptoms typically emerge. Common indicators of cardiomyopathy include:

• Breathlessness: This may occur during physical exertion or even at rest, indicating that the heart is struggling to meet the body’s oxygen demands.
• Swelling: Many patients experience swelling in the legs, ankles, and feet, which is often due to fluid retention.
• Abdominal bloating: Fluid accumulation can also lead to a sensation of fullness or bloating in the abdomen.
• Coughing: Some individuals may develop a persistent cough, particularly when lying down, which can be a sign of fluid buildup in the lungs.
• Fatigue: A general feeling of tiredness or weakness is common, as the heart’s reduced efficiency can lead to decreased energy levels.
• Irregular heartbeats: Patients may notice their heart racing, pounding, or fluttering, which can be alarming.
• Chest pain: Discomfort or pain in the chest may occur, adding to the overall distress of the condition.
• Dizziness: Feelings of light-headedness or fainting can also happen, particularly during physical activity.

Possible causes of cardiomyopathy

In many cases, the exact cause of cardiomyopathy remains unclear. However, certain factors have been identified that may contribute to the development of this condition. These potential causes include:

• Genetic conditions: Inherited genetic mutations can predispose individuals to cardiomyopathy.
• Long-term high blood pressure: Chronic hypertension can place excessive strain on the heart muscle over time.
• Heart tissue damage: Previous heart attacks can lead to scarring and damage, affecting the heart's function.
• Chronic rapid heart rate: Persistent tachycardia can weaken the heart muscle over time.
• Heart valve problems: Malfunctioning heart valves can disrupt blood flow and increase the heart's workload.
• Metabolic disorders: Conditions such as obesity, thyroid disease, and diabetes can influence heart health.
• Nutritional deficiencies: A lack of essential vitamins or minerals, particularly thiamine (vitamin B-1), can adversely affect heart function.
• Pregnancy complications: Certain issues during pregnancy may increase the risk of developing cardiomyopathy.
• Alcohol consumption: Chronic excessive drinking can lead to alcoholic cardiomyopathy, damaging the heart muscle.
• Drug use: The use of substances such as cocaine, amphetamines, or anabolic steroids can harm the heart.
• Chemotherapy drugs and radiation: Some cancer treatments can have detrimental effects on heart health.
• Infections: Certain infections may injure the heart and trigger cardiomyopathy.
• Iron overload: Conditions like hemochromatosis can result in excess iron accumulation in the heart muscle.
• Sarcoidosis: This inflammatory condition can lead to the growth of cell clusters in the heart and other organs.
• Connective tissue disorders: Various disorders affecting connective tissues can also contribute to cardiomyopathy.

How to register on the chronic programme

If you have been diagnosed with Addison’s disease, it is important to take steps to ensure you receive the necessary treatment. You should ask your doctor to reach out to our Chronic Medicine Department by calling 0860 11 78 59. This call will initiate your registration on the Chronic Medicine Management Programme. A chronic medicine consultant will collaborate with your healthcare provider regarding your treatment plan. Once the necessary diagnostic criteria are met and your blood test results are submitted, your treatment will be reviewed for approval. You will be informed whether your treatment is included in the Momentum Medical Scheme formulary or if you will be required to make a co-payment. After receiving authorization, you can present your prescription to your designated service provider to obtain your medication, and the claim will be processed accordingly.

A designated service provider (DSP) refers to a healthcare provider, such as a doctor, pharmacist, or hospital, that is preferred by the medical scheme for diagnosing and treating members with Prescribed Minimum Benefit conditions. If you choose to use a provider that is not designated, you may incur additional co-payments. Typically, the authorization for your treatment will expire after 12 months. If your medication remains unchanged, your doctor or pharmacist can contact us at 0860 11 78 59 to renew the authorization. This same procedure applies if there are any modifications or additions to your treatment plan.

For further details regarding your chronic benefits and where to obtain chronic medications and treatments, please click here.

Hospitalization

In the event that you require hospitalization due to complications related to cardiac failure, you can easily access support through the Momentum App. You can also reach out to us via the web chat feature available on momentummedicalscheme.co.za, send an email to [e-mail], or contact us via WhatsApp or by calling 0860 11 78 59. Upon your request for pre-authorization, we will assign a case manager to monitor and assist with your hospital stay.

Treatment plan

Once you have successfully registered on the chronic programme, you will gain access to a comprehensive treatment plan. This plan may encompass coverage for necessary tests, visits to healthcare providers, and other benefits deemed medically essential by your physician. Our clinical team will review these benefits to ensure they are appropriate and necessary for your condition.

Compliance

It is crucial for your health and treatment outcomes that you adhere to the following compliance measures:

• Ensure that you obtain your chronic medication on a monthly basis.
• Follow the prescribed dosage and quantity as directed by your healthcare provider.
• Do not miss any doses of your medication, as this can seriously impact your health and overall wellbeing.

Please make sure your claims have the appropriate ICD-10 code

For the smooth processing of your claims, it is essential that all submissions include the correct ICD-10 codes, which are diagnostic codes. This allows us to accurately identify and process your claim under the Chronic Benefit.

We may pay claims from your Day-to-day Benefits if:

• The claims are submitted without the relevant ICD-10 codes.
• You have exceeded the allowable frequency for consultations or tests.
• The treatment provided is not deemed clinically appropriate.

Contact us

If you have any questions or need assistance, you can reach out to us through the web chat feature on momentummedicalscheme.co.za, email us at [e-mail], send a WhatsApp message, or call us at 0860 11 78 59.

Glossary of terms

Designated service providers: Momentum Medical Scheme utilizes a network of designated service providers, including associated general practitioners and specialists, as well as state facilities, to ensure that our members receive appropriate diagnosis and treatment for Prescribed Minimum Benefits.

A formulary: This is a list of medications that are covered under your specific option, from which your doctor can prescribe the most suitable medications for your chronic condition.

ICD-10: This refers to the International Classification of Diseases, 10th Revision, which is the coding system used for diagnosis.

Prescribed Minimum Benefits: This term refers to a set of benefits that all medical schemes in South Africa are required to cover according to the Medical Schemes Act 131 of 1998 and its regulations. To access these benefits, your medical condition must qualify and be included in the defined list of Prescribed Minimum Benefit conditions, the necessary treatments must align with the defined benefits, and you must utilize the Scheme’s designated service providers. For further clarification on designated service providers, please refer to the definition provided on page 2.

If you opt to use non-designated service providers voluntarily, the Scheme will cover benefits up to the Momentum Medical Scheme Rate, and relevant co-payments will apply. However, if you require non-designated service providers in an emergency medical situation, this is considered involuntary, and co-payments will be waived.