Description

Hypertrophic cardiomyopathy (HCM) is a disease in which the heart muscle becomes thicker, also called hypertrophy. The thickening of the heart muscle can make it harder for the heart to pump blood.

Many people with hypertrophic cardiomyopathy do not realize they have it. That's because they have few, if any, of the symptoms. But in a small number of people with the disease , thickening of the heart muscle can cause serious symptoms. These include shortness of breath and chest pain. Some people with the disease have changes in the heart's electrical system. These changes can result in life-threatening irregular heartbeat or sudden death.

Symptoms

The symptoms of hypertrophic cardiomyopathy may include one or more of the following:

  • Chest pain, especially during exercise.
  • Fainting, especially during or just after exercise or other physical activity.
  • The sensation of rapid, pounding or throbbing of the heart are called heart palpitations.
  • Shortness of breath, especially during exercise.

When to see a doctor

Many conditions can cause shortness of breath and rapid heartbeat. It is important to get a prompt check to find the cause and get appropriate care. Consult your health care professional if you have a family history of HCM or any of the symptoms related to hypertrophic cardiomyopathy.

Call 911 or the local emergency number if you have any of the following symptoms for more than a couple of minutes:

  • Rapid or irregular heartbeat.
  • Difficulty breathing.
  • Pain in the chest.

Causes

Hypertrophic cardiomyopathy is usually caused by changes in genes that cause the heart muscle to thicken.

Hypertrophic cardiomyopathy usually affects the wall between the two lower chambers of the heart. This wall is called the septum. The chambers are called ventricles. The thickening of the wall may block the flow of blood out of the heart. This is called hypertrophic obstructive cardiomyopathy.

If there is no significant blockage of the flow of blood, the condition is called non-obstructive hypertrophic cardiomyopathy. But the heart's main pumping chamber called the left ventricle, it could harden. This makes it difficult for the heart to relax. The stiffness also decreases the amount of blood that the ventricle may withhold and send to the body with each beat of the heart.

Cardiac muscle cells also become arranged differently in people with hypertrophic cardiomyopathy. This is called myofibrillar disarray. It can cause irregular heartbeat in some people.

Risk factors

Hypertrophic cardiomyopathy is usually passed through families. That means that it is inherited. People with a parent with hypertrophic cardiomyopathy have a 50% chance of having the gene change that causes the disease.

Fathers, sons, or brothers, or sisters, of a person with hypertrophic cardiomyopathy should ask your health care team about screening tests for the disease.

Complications

The complications of hypertrophic cardiomyopathy can include:

  • Atrial fibrillation (AFib). A thickening of the heart muscle and the changes in the structure of the cells of the heart may trigger an irregular and often very fast heart beat, called atrial fibrillation. Atrial fibrillation also increases the risk of blood clots that can travel to the brain and cause a stroke.
  • Blocks the flow of blood. In many people, the thickening of the heart muscle blocks the flow of blood out of the heart. This can cause shortness of breath with activity, chest pain, dizziness, and fainting.
  • Mitral valve disease. If the thickening of the heart muscle blocks the flow of blood leaving the heart, the valve between the left heart chambers may not close properly. The valve is called the mitral valve. If you don't close properly, blood can leak back into the top-left of the camera. This is a condition known as mitral valve regurgitation. You could do the hypertrophic cardiomyopathy symptoms worse.
  • Dilated cardiomyopathy. In a small number of people with the disease , thickening of the heart muscle becomes weak and does not work well. The condition tends to start in the lower left chamber of the heart. The camera becomes larger. The heart pumps with less force.
  • Heart failure. Over time, the thickening of the heart muscle may become too stiff to fill the heart with blood. As a result, the heart cannot pump enough blood to meet the body's needs.
  • Fainting, also called syncope. An irregular heartbeat or the obstruction of the flow of blood can sometimes cause fainting. Unexplained fainting may be related to sudden cardiac death, especially if what has happened recently and in a young person.
  • The sudden cardiac death. Rarely, hypertrophic cardiomyopathy can cause heart-related sudden death in people of all ages. Many people with hypertrophic cardiomyopathy do not realize they have it. As a result, sudden death may be the first sign of the disease. It can happen in young people, who appear healthy, as high school athletes and other young, active adults.

Prevention

There is No known way to prevent the hypertrophic cardiomyopathy (HCM). It is important to find the condition with proof as soon as possible, to guide treatment and prevent complications.

Hypertrophic cardiomyopathy is usually transmitted in families. If you have a parent, brother, sister or child with hypertrophic cardiomyopathy, ask your health care team if genetic screening is right for you. But not everyone with the disease has a change in the gene tests can detect. In addition, some insurance companies do not cover genetic testing.

If genetic testing is not done, or if the results are not useful, the analysis can be done with the repetition of the echocardiograms. The echocardiogram uses sound waves to create images of the heart.

For the people that have a family member with hypertrophic cardiomyopathy:

  • Echocardiogram projections is recommended from the age of 12 years.
  • The screening echocardiograms should follow every 1 to 3 years through the ages 18 to 21.
  • After that, the tests may be performed every five years through adulthood.

You may need to have an echocardiogram more often based on your overall health and the health of the team of preference.

Diagnosis

A healthcare professional examines and listen to your heart with a device called a stethoscope. A heart murmur can be heard while listening to the heart.

A member of the health team usually asks questions about your symptoms and your medical and family history. Genetic testing or counseling may be recommended if you have a family history of the disease.

Tests

Tests are done to check the heart and search for the causes of the symptoms.

  • The echocardiogram. An echocardiogram is often used for the diagnosis of hypertrophic cardiomyopathy. Use sound waves to create images of the beating heart. This test indicates the shape of the heart chambers and valves of the pumping of the blood. An echocardiogram can also see if the heart is the muscle that is thicker than it should be.
  • Electrocardiogram (ECG or EKG). This quick and painless test that measures the electrical activity of the heart. Sticky patches called electrodes are placed on the chest and sometimes the arms and legs. The wires connect the electrodes to a computer, that prints or displays the results of the test. An ECG may show an irregular heartbeat and signs of heart thickening.
  • Holter Monitor. This small portable ECG device that records the heart's activity. It is used for a day or two while you do your regular activities.
  • CardiacMRI. This test uses powerful magnets and radio waves to create images of the heart. Provides information on the cardiac muscle and how the heart and the heart valves work. This test is often done with an echocardiogram.
  • Stress test. A stress test often consists of walking on a treadmill or riding a stationary bike while the heart is controlled. Stress tests help reveal how the heart responds to physical activity.
  • CardiacCTscan. Rarely, this test is done to diagnose hypertrophic cardiomyopathy. But you can suggest if a magnetic resonance imaging cannot be used. A cardiac ct scan uses X-rays to create images of the heart and the chest. It can show the size of the heart.

Treatment

The objectives of the hypertrophic cardiomyopathy treatment are to relieve symptoms and prevent sudden cardiac death in high-risk persons. The treatment depends on the severity of the symptoms.

If you have cardiomyopathy and are pregnant or thinking about pregnancy, talk with your health care professional. You may be referred to a physician with experience in high-risk pregnancies. This doctor might be a perinatologist or a maternal-fetal medicine specialist.

Drugs

Medications can help to reduce strongly the heart muscle contracts and decreases the heart rate. That way, the heart can pump blood better. Medications for the treatment of hypertrophic cardiomyopathy and symptoms may include:

  • Beta-blockers, such as metoprolol (Lopressor, Toprol XL), propranolol (Inderal LA, Innopran XL) or atenolol (Tenormin).
  • Calcium channel blockers such as verapamil (Verelan) or diltiazem (Cardizem, Tiazac, others).
  • A medicine called mavacamten (Camzyos) that reduces the strain on the heart. You can treat obstructive HCM in adults with symptoms. Your health care team may suggest that this medication if you can't take or do not improve with beta-blockers or verapamil.
  • Heart rhythm medications, such as amiodarone (Pacerone) or disopyramide (Norpace).
  • Blood thinners such as warfarin (Jantoven), dabigatran (Pradaxa), rivaroxaban (Xarelto), or apixaban (Eliquis). Blood thinners can help prevent blood clots if you have atrial fibrillation, or the apical type of hypertrophic cardiomyopathy. Apical HCM may increase the risk of sudden cardiac death.

Surgeries or other procedures

After multiple surgeries or procedures are available for the treatment of cardiomyopathy or its symptoms. They include:

  • Septal myectomy.This open-heart surgery may be recommended if medications don't improve symptoms. It is the removal of part of the thickened, covered wall between the chambers of the heart. This wall is called the septum. Septal myectomy helps to improve the flow of blood out of the heart. It also reduces the retrograde flow of blood through the mitral valve. The surgery can be done using different approaches, depending on the location of the thickening of the heart muscle. In one type, called apical myectomy, surgeons remove thickening of the heart muscle near the tip of the heart. Sometimes the mitral valve is repaired at the same time.
  • The ablation Septal. This procedure uses the alcohol to reduce the thickening of the heart muscle. A long, thin tube called a catheter is placed in an artery that supplies blood to the affected area. The Alcohol flows through the tube. Changes in the heart's electrical signaling system, also called a heart block, is a complication. A heart block should be treated with a pacemaker. The small device that's placed in the chest to help control your heartbeat.
  • An Implantable cardioverter defibrillator (ICD). This device, which is placed under the skin near the collarbone. Constantly checks the heart's rhythm. If the device finds an irregular heartbeat, sends low-or high-energy shock to reset the heart's rhythm. The use of an icd has been shown to help prevent sudden cardiac death, which occurs in a small number of people with hypertrophic cardiomyopathy.
  • Cardiac resynchronization therapy (CRT) device. Rarely, this implanted device is used as a treatment for hypertrophic cardiomyopathy. You can help the chambers of the heart to squeeze in a more organized and efficient.
  • Ventricular assist device (VAD). This implanted device also rarely used for the treatment of hypertrophic cardiomyopathy. This helps the flow of blood through the heart.
  • Heart transplant. This is a surgery to replace a diseased heart with a donor heart healthy. It may be a treatment option for end-stage heart failure when medications and other treatments do not work.

Septal myectomy. This open-heart surgery may be recommended if medications don't improve symptoms. It is the removal of part of the thickened, covered wall between the chambers of the heart. This wall is called the septum. Septal myectomy helps to improve the flow of blood out of the heart. It also reduces the retrograde flow of blood through the mitral valve.

The surgery can be done using different approaches, depending on the location of the thickening of the heart muscle. In one type, called apical myectomy, surgeons remove thickening of the heart muscle near the tip of the heart. Sometimes the mitral valve is repaired at the same time.

Lifestyle and home remedies

Lifestyle changes can reduce the risk of complications associated with hypertrophic cardiomyopathy. Try these healthy habits:

  • Exercise. Ask your health care professional about the amount and type of exercise is safe for you.
  • Eat a healthy diet. Eat a healthy diet, low in salt and solid fats and rich in fruits, vegetables and whole grains.
  • Do not smoke. If you smoke and can't stop smoking on your own, talk to a health professional about strategies or programmes of assistance.
  • Stay at a healthy weight. This helps to prevent excess stress on the heart. It also reduces the health risks associated with surgery or other procedures. Talk with your care team to set realistic goals for body mass index (BMI) and weight.
  • Limit or avoid alcohol. Sometimes, the irregular rhythms of the heart and blocks blood flow are caused or exacerbated by the use of alcohol. Ask your healthcare professional how much alcohol, if any, is safe to drink. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink per day for women and up to two drinks per day for men.
  • Control of blood pressure and cholesterol. High blood pressure and high cholesterol increases the risk of heart disease. Make lifestyle changes and take medications as directed to manage high blood pressure or high cholesterol. Get health checkups. Your healthcare provider may recommend regular follow-up appointments to check on your condition. Tell your healthcare team if you have new or worsening symptoms.
  • Practice good sleep habits. Lack of sleep can increase the risk of heart disease and other chronic conditions. Adults should aim to get 7 to 9 hours of sleep daily. Go to bed and wake up at the same time every day, including weekends. If you have trouble sleeping, talk with a health professional about strategies that might help.

Coping and support

Connect with friends and family, or a support group. You can find that talk about hypertrophic cardiomyopathy with others in similar situations can help.

It is also important to control the emotional stress. Do more exercise and practice of care are the ways to relieve stress. If you have anxiety or depression, talk with your health care team about the strategies to help.

Preparing for your appointment

You may be referred to a doctor trained in heart disease. This kind of professional attention is called to a cardiologist. Here's some information to help you prepare for your appointment.

What you can do

When you make the appointment, ask if you need to follow all the restrictions that existed before the fix. For example, you may need to change your activity level or diet. Make a list of:

  • Your symptoms and when they began.
  • All the drugs, vitamins, and supplements you are taking, including dosage.
  • Key medical information, including other conditions, and family history of heart disease.
  • Questions to ask your health care professional.

Questions to ask your health care professional may include:

  • What is the most likely cause of my symptoms?
  • What tests do I need?
  • What treatments can help?
  • What are the risks associated with my heart condition to create?
  • How often will I need follow-up appointments?
  • Do I need to limit my activities?
  • Should my children or other relatives of the first degree to be selected for this condition, and should meet with a genetic counselor?
  • How will other conditions you have or medications I take affect my heart disease?

Feel free to ask other questions that you may have.

What to expect from your doctor

Your healthcare provider will likely ask questions such as:

  • How severe are the symptoms?
  • The symptoms changed over time? If so, how?
  • Exercise or physical effort to make your symptoms worse?
  • Have you ever fainted?

What you can do in the meantime

Prior to his appointment, the members of your family if any of your relatives have been diagnosed with hypertrophic cardiomyopathy, or have had unexplained and sudden death.

If exercise makes your symptoms worse, not do vigorous exercise until you have seen your health care professional. Ask for specific exercise recommendations.

Symptoms and treatment of Hypertrophic cardiomyopathy