What is hypertrophic cardiomyopathy?

Hypertrophic cardiomyopathy occurs when the heart muscle cells enlarge and cause the ventricle walls to enlarge (typically the left ventricle). The cause of the ventricular wall thickening is unknown and microscopic examination of the heart muscle is abnormal.

As the disease progresses, hypertrophic cardiomyopathy can lead to heart failure, arrhythmias or heart valve issues.

Dilated Cardiomyopathy

Causes of hypertrophic cardiomyopathy

The exact cause of hypertrophic cardiomyopathy is unknown. The condition is inherited and in some cases due to a change in genes in the heart muscle proteins.

Some cases of hypertrophic cardiomyopathy have been known to develop over time in patients who are aging, have diabetes, thyroid disease or have high blood pressure.

Risk factors for hypertrophic cardiomyopathy

Risk factors that can increase your risk of developing hypertrophic cardiomyopathy include:

  • Family history
  • High blood pressure
  • Prior heart disease
  • Being overweight or obese
  • Excessive drinking
  • Excessive drug use
  • Cancer treatments
  • Diabetes

Symptoms of hypertrophic cardiomyopathy

Some patients with hypertrophic cardiomyopathy do not experience any symptoms, while others have severe symptoms.

Signs or symptoms of hypertrophic cardiomyopathy include:

  • Shortness of breath
  • Serious arrhythmias
  • Inability to exercise or perform daily activities
  • Chest pain
  • Dizziness
  • Fainting

Diagnosis of hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy is diagnosed in a full physical exam with your doctor. Your physician will take your full medical history, evaluate your symptoms and order an echocardiogram to show if your heart muscle is abnormally thick, if your heart valves are functioning correctly or if blood flow is obstructed.

If initial results are inconclusive, the doctor may order further diagnostic testing or procedures such as:

  • Blood test — blood tests can show increases in iron levels as well as check your kidney, thyroid or liver function.
  • Chest x-Ray — a chest x-ray of the heart, lungs and blood vessels can detect an enlarged heart as well as fluid on the lungs.
  • Electrocardiogram (ECG or EKG) — measures electrical impulses in the heart and can determine if you have an enlarged heart chamber or irregular heart rhythms.
  • Exercise stress test — stress tests while exercising (typically on a treadmill or stationary bike) can evaluate your heart rhythm, blood pressure and breathing.
  • Holter (event) monitors — a portable device that measures a patient’s electrical activity for 24 to 48 hours.
  • Cardiac MRI (magnetic resonance imaging) — creates images of your heart using magnetic fields and radio waves.
  • Cardiac catheterization — a minimally invasive procedure that is used to determine if you have vessel blockages and where they are located.
  • Myocardial biopsy — a piece of your heart muscle is removed (typically during a cardiac catheterization) and studied under a microscope to determine if you have hypertrophic cardiomyopathy.

Treatments for hypertrophic cardiomyopathy

Some patients who have cardiomyopathy but do not have symptoms may not need treatment, but for others treatment is crucial. You will work with your Mercy Health heart and vascular team to customize a treatment plan for you.

The goals of treatment are to manage contributing conditions, reduce risk of sudden cardiac arrest, stop the disease from getting worse and control the symptoms so you can live a normal life.

Lifestyle changes

Lifestyle changes recommended for patients with hypertrophic cardiomyopathy include:

  • Eat a healthy diet full of fruits, vegetables and whole grains
  • Avoid alcohol
  • Maintain a healthy weight
  • Avoid smoking or second-hand smoke
  • Rest
  • Treat conditions such as high blood pressure or diabetes

Medication

There are a variety of medications to treat the symptoms of hypertrophic cardiomyopathy including:

  • High blood pressure — blood pressure medications such as ACE inhibitors, beta blockers and calcium channel blockers can be used to lower blood pressure.
  • Rapid heart rate — beta blockers, calcium channel blockers and digoxin can stabilize heart rate.
  • Irregular heartbeats — antiarrhythmics prevent arrhythmias and help keep your heart beating in a normal rhythm.
  • Fluid retention — diuretics can help remove excess fluid and sodium from the body.
  • Inflammation — corticosteroids can reduce inflammation in patients with hypertrophic cardiomyopathy.
  • Blood clots — anticoagulants (blood thinners) can prevent blood clots.

Minimally-invasive septal ablation

Minimally-invasive septal ablation, also known as alcohol septal ablation, is a minimally invasive treatment for patients with severe hypertrophic cardiomyopathy who are not candidates for surgery.

Patients must meet strict physiological, anatomic and clinical criteria to be eligible for this procedure.

During the procedure, a small amount of alcohol is injected into the heart wall causing part of the muscle to shrink, which enables blood to flow freely in and out of the heart. A highly skilled interventional cardiologist should perform this specialized procedure. When completed successful, 90% of patients experience symptom relief.

Surgical removal or septal myectomy

A septal myectomy is an open-heart surgery performed by a cardiothoracic surgeon to remove part of the thickened septum that is bulging into the left ventricle.

The surgery can help improve blood flow in the heart and allows patients to return to a normal life without symptoms.

This procedure is typically performed on younger patients who have severe obstructive hypertrophic cardiomyopathy.

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