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Hypertrophic Obstructive Cardiomyopathy – Nate Schwartz’s Story

Nat Schwartz

It’s not often that you see a patient in a cardiology office in his late teenage years, but for Nate Schwartz, it was a decision he made to see a cardiologist that potentially saved his life.

“When I was about 18 or 19, I suddenly was getting very short of breath,” said Nate. His dad has suffered a heart attack at the age of 26 and ultimately received a heart transplant; initially doctors thought it was a virus, but they later came to believe that it was a genetic mutation that caused his sudden cardiac condition. When Nate visited the University of Utah cardiology department in his late teens—getting care from many of the same team members who had treated his dad years earlier—they determined he had hypertrophic cardiomyopathy (HCM).

“Hypertrophic cardiomyopathy is inherited and tends to run in families,” said Omar Wever-Pinzon, MD, medical director of hypertrophic cardiomyopathy at University of Utah Health. “This condition is a change in the genetic code, and leads to hypertrophy, meaning that the heart muscle becomes enlarged,” This enlargement makes it difficult for the heart’s chambers to properly fill with blood.

HCM impacts about 1 in 200 people, but there is a smaller subset of patients—around 25 percent of HCM patients, according to Stephan McKellar, MD, cardiothoracic surgeon at U of U Health—who have an obstruction along with HCM. 

“Nate Schwartz had two problems, one of them the HCM, the other a bulge in the part of his heart that obstructed the blood flow from leaving the heart,” said McKellar. “That can cause more shortness of breath, dizziness, fainting spells, and even sudden cardiac death if that obstruction is too severe and blood can’t leave the heart to go to the brain and the rest of the body.”

After scans revealed HCM, Nate got a pacemaker and was working on regulating his condition with medication and other therapies, but within a couple of years he was in complete heart failure. He spent the better part of a year either in bed or in and out of the hospital; just getting up to his second floor apartment was often the only thing he could manage to do for the day.

At that time Wever-Pinzon referred Nate to McKellar to discuss options for a septal myectomy, a surgical procedure where the surgeon removes a portion of the muscle that is obstructing blood flow in the heart.

There aren’t a lot of people in the country who feel comfortable performing these surgeries because they are not common, according to McKellar, and those who do them have to be careful to remove exactly the right amount of muscle. Not removing enough means the patient will still suffer from obstructive issues, but removing too much can cause other heart defects that are difficult to fix. Fortunately during McKellar’s training he saw and participated in several septal myectomies, so Nate was in good hands.

The surgery itself is pretty straightforward and the prognosis for patients is very good, said McKellar. Unlike some other cardiovascular surgeries, patients often feel immediately better when this one is completed.

“I could tell almost instantly how much better I was feeling,” said Nate. “They break your chest [in surgery] so I was in pain, but I had this energy that I’ve never had.”  

Nate and his sister also underwent genetic testing to find out whether they had the genetic mutation that leads to HCM (he does, his sister does not). He had previously worried that he might die from cardiovascular disease at a young age like his father, but today the treatment he’s receiving has already improved his outlook significantly over what his dad was facing at the same age.

“What people need to know in their family history is [whether they have] anybody with an enlarged heart, heart failure, heart transplantation, or sudden cardiac arrest at a young age, younger than 40,” said Wever-Pinzon. In those cases, you should see a cardiologist about HCM.

Now that he knows the “rules” he has to play by, Nate can do the things he wants to do, especially traveling. A student in linguistics, he had the chance to spend some time in Japan last summer studying the language and culture, something he knows would never have been possible before the surgery.

“That was a really big opportunity that, if I wasn’t getting my health care, I wouldn’t have the physical ability to have done,” said Nate.