Treatment for Hypertrophic Cardiomyopathy
Treating patients with HCM is guided by how severe symptoms are, whether a patient has any risk factors for sudden cardiac death, and whether a patient has cardiac arrhythmias and other associated problems. Treating patients with HCM is typically coordinated by a multidisciplinary team and includes the following goals:
- Treating symptoms
- Doing a risk assessment and preventing sudden cardiac death
- Making recommendations for physical activity
- Managing co-morbidities (such as hyperlipidemia, coronary artery disease, or sleep apnea)
- Testing first degree relatives to see if they have the HCM mutation
Symptoms of HCM
Symptoms of HCM are different depending on how old you are. Most patients with HCM don’t have many symptoms. For this reason, a doctor may discover HCM during a routine appointment for other issues. Some patients with HCM have cardiac arrhythmias (irregular heartbeat), heart failure symptoms, or sudden cardiac death.
Early Stage Symptoms
In the early stages of HCM, you may experience any of the following:
- Chest discomfort
- Shortness of breath
- Fainting or dizziness (particularly with exercise)
Over time, HCM can get worse and cause heart failure with symptoms of shortness of breath, chest discomfort, and edema. HCM can also cause atrial fibrillation, which increases your chances for stroke. In addition, HCM can cause sudden cardiac death because of ventricular arrhythmias (abnormal rapid heartbeats).
Most patients with HCM have minor to no symptoms. If your doctors determine that you have a low risk of sudden cardiac death, you won’t need treatment.
For patients who have symptomatic hypertrophic obstructive cardiomyopathy (HOCM), the first treatment is medical therapy. Medical therapy for HCM includes using beta-blocker or a non-dihydropyridine calcium channel blocker. In patients with persistent obstruction, disopyramide is a safe and effective way to relieve obstruction and improve symptoms.
Septal Myectomy for HCM
Septal myectomy is a surgical procedure where doctors cut out (excise) part of the hypertrophied (thickened) and asymmetric heart wall (also called the septum). Septal myectomy is considered the gold-standard approach for septal reduction.
Alcohol Septal Ablation
Sometimes patients have HOCM symptoms that don’t improve with medical therapy. Some of these patients are considered too high-risk to have surgery, or they simply prefer not to have surgery. For these patients, doctors can perform a catheter-based percutaneous alcohol septal ablation is an alternative.
Alcohol septal ablation is a procedure that tries to decrease the thickness of the septum (heart wall). To do this, doctors safely induce a myocardial infarction (heart attack) in a controlled setting. Doctors perform this procedure in our cardiac catheterization lab.
In patients with non-obstructive HCM, symptoms are generally treated with medical therapy. This is because patients who don’t have obstruction don’t need to have their septum thinned. Some patients with HCM may develop end-stage heart failure. These patients may need heart transplant surgery.
Preventing Sudden Cardiac Death
Fortunately, sudden cardiac death that happens because of ventricular arrhythmias is a rare for patients with HCM. Our multidisciplinary team will assess each patient’s risk for cardiac death using population studies.
American and European guidelines and calculators were created to estimate the risk of sudden death in HCM. But unfortunately, the accuracy of these risk models isn’t perfect. Doctors recommend an implantable cardioverter defibrillator (ICD) in patients who have a higher chance of having sudden cardiac death. An implantable cardioverter defibrillator (ICD) will pace or shock a patient’s heart if they have a life-threatening arrhythmia.
Lifestyle & Management
Recommendations for Physical Activity
Participating in competitive or high-intensity athletics is considered risky for sudden cardiac death in patients with HCM. For this reason, doctors discourage patients with HCM from playing sports. Patients are allowed to practice low-impact recreational sports. However, it’s important for patients to always self-limit their activity (or rest whenever they feel the need to do so).
Patients should plan their individual exercise program with their doctor so that all factors can be taken into consideration.
Managing Additional Conditions (Comorbidities)
Patients with HCM have higher chances of developing other heart conditions (called comorbidities). These include:
Doctors treat these conditions according to current guidelines and heart research.
Testing First Degree Relatives
We recommend that first degree relatives receive testing and diagnostic evaluation for HCM. Our doctors will perform genetic testing or electrocardiograms and echocardiograms based on the relative’s age.