Hypertrophic Cardiomyopathy (HCM) - Symptoms, Causes, Types and Treatment

Hypertrophic Cardiomyopathy is a disorder characterized by the thickening of the heart muscles or the walls between the heart ventricles. This thickening of the muscles makes it harder for the heart to pump blood efficiently. 

The condition often goes undiagnosed as the disease does not show any apparent symptoms. However, in a few cases, the thickened muscles lead to chest pain, shortness of breath, and changes in the electric rhythm of the heart. All these can lead to serious consequences such as arrhythmias or sudden cardiac death.

What are The Symptoms of Hypertrophic Cardiomyopathy?

Common symptoms associated with hypertrophic cardiomyopathy include:

• Chest pain, especially after exertion or exercise
• Fainting, especially after exertion or exercise
• Palpitation or fast, pounding, or fluttering heartbeats
• Heart murmurs
• Shortness of breath, especially after exertion or exercise

What are The Possible Causes of Hypertrophic Cardiomyopathy?

In most cases, Hypertrophic Cardiomyopathy is inherited. However, in many cases, the cause of Hypertrophic Cardiomyopathy is not identified. Possible causes include:

• Genetics: Your heart muscle can thicken due to mutated genes. Hypertrophic Cardiomyopathy follows a dominant pattern, which means that having just one gene associated with this disorder can make the symptoms appear. If someone in your family has Hypertrophic Cardiomyopathy, consult your healthcare provider and get yourself tested to know if you are a carrier of the gene mutation.

• High blood pressure: Increase in blood pressure as you get older can also lead to more serious side effects such as Hypertrophic Cardiomyopathy.

What Are The Types of Hypertrophic Cardiomyopathy?

Hypertrophic Cardiomyopathy can be broadly classified into two main types:

• Obstructive Hypertrophic Cardiomyopathy: This is the most common type of Hypertrophic Cardiomyopathy. In this condition, the wall between the right and light ventricle thickens and blocks the flow of blood from your left ventricle to your aorta.

• Non-obstructive Hypertrophic Cardiomyopathy: In this type of Hypertrophic Cardiomyopathy, the muscles of your heart thicken but there is no blockage of blood flow.

How is Hypertrophic Cardiomyopathy Treated?

Treatment for Hypertrophic Cardiomyopathy focuses on preventing complications such as sudden cardiac death and alleviating the symptoms associated with the condition. The choice of treatment will vary from one person to the other depending on:

• The symptoms you are experiencing
• Activity level
• Your age
• Outflow obstruction
• Your heart function

Standard treatment options for Hypertrophic Cardiomyopathy include:

• Medications: If you are experiencing any symptoms of Hypertrophic heart disease, your healthcare provider will prescribe you medications such as calcium channel blockers and beta-blockers. These medicines work to relax the heart muscles. If you are experiencing irregular heart rhythm, your physician may prescribe antiarrhythmic medications like:

o   Sotalol

o   Amiodarone

o   Disopyramide

• Recently, researchers have discovered a drug known as mavacamten (MyoKardia) for the treatment of symptomatic cardiomyopathy. In human trials, it was found that this medication helps in improving physical functioning and reducing symptoms. It works by impeding cardiac myosin, a protein that helps in the contraction of the heart.

• Septal Myectomy: This is a type of open-heart surgery that is performed to remove a part of the thickened heart muscle or septum. The septum is the muscles present between the two chambers or ventricles in your heart. The procedure helps in boosting the flow of blood through the heart. This surgery is only recommended if medication fails to reduce the symptoms of Hypertrophic heart disease.

• Septal Ablation: This procedure involves the use of alcohol to rescind a part of the thickened heart muscle. In this procedure, alcohol is injected into the arteries through a catheter. The arteries, in turn, supply the alcohol to the thickened part of the heart muscles which require treatment.  

• Pacemaker Implantation: If you have been experiencing an irregular heart rhythm and rate due to hypertrophic cardiomyopathy, a small electronic device may be placed on your chest under the skin to help regulate your heart rate. The pacemaker sends regulated electric signals to your heart and helps regulate your heartbeat.

• Implantable Cardioverter Defibrillator: ICD, or implantable cardioverter defibrillator, is a tiny device that tracks your heartbeat using electric shocks and fixes atypical and dangerous heart rhythms. The device is implanted inside your chest and is recommended for people who are at a higher risk of suffering from sudden cardiac death.

• Lifestyle changes: If you are living with hypertrophic cardiomyopathy, your doctor will recommend you change your lifestyle habits to reduce your chances of complications. These include consuming a healthy diet, indulging in regular low-intensity workouts, maintaining a healthy weight, restricting high-impact workouts, and focusing on low-impact workouts including bowling, golfing, or walking. You will also be asked to limit your alcohol intake as it can lead to atypical heart rhythms.

How Can You Prevent Hypertrophic Cardiomyopathy?

There is no way to prevent hypertrophic cardiomyopathy. The key is to identify the condition as soon as possible to prevent complications and get the right course of treatment. If someone in your family or your loved one is living with hypertrophic cardiomyopathy, you may be asked to go for genetic testing to figure out if you are at risk of this condition as well. 

If the results of genetic testing are not helpful, your doctor may recommend you to go for repeat echocardiography if your close family members have hypertrophic cardiomyopathy. Competitive athletes and adolescents should also get screened at least once a year. On the other hand, people who do not compete in sports should get themselves tested at least once every 5 years.

Conclusion

Most people with hypertrophic cardiomyopathy (HCM) lead normal lives, but several treatments are available for people who develop symptoms or are at risk for serious problems. Your outlook (prognosis) depends on how well your heart muscle is working, your symptoms, and how well you respond to and follow your treatment plan. 

Ask your healthcare provider about your risk and the steps you can take to improve your quality of life and prevent infection. If you are diagnosed with hypertrophic cardiomyopathy and develop symptoms or are worried about an infection, reach out to your healthcare provider right away