The heart is a muscle, and it is also affected in Duchenne. Heart muscle disease is called “cardiomyopathy”. In Duchenne, cardiomyopathy is a result of a lack of dystrophin in the heart muscle. Cardiomyopathy causes decreased function of the heart, or heart failure over time. There are many levels of heart failure, and people can live with managed heart failure for many years with the use of medication and regular visits to a cardiologist (heart doctor). The aim of cardiac management in Duchenne is early detection and treatment of heart muscle changes. Unfortunately, heart problems can often be silent and you may not notice symptoms. For this reason, it is extremely important to involve a cardiologist as a member of your care team from the time of diagnosis (see figure 11).