Hypertrophic Cardiomyopathy
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Hypertrophic Cardiomyopathy

(Cardiomyopathy, Hypertrophic; HCM; Idiopathic Hypertrophic Subaortic Stenosis; Asymmetric Septal Hypertrophy; ASH; HOCM; Hypertrophic Obstructive Cardiomyopathy)

Pronounced: hi-per-TRO-fik car-DEE-o-my-AH-pah-thee

En Español (Spanish Version)

Definition

Hypertrophic cardiomyopathy, or HCM, is a form of cardiomyopathy. This is a condition in which the heart muscle thickens. As the muscle thickens, it must work harder to pump blood, which strains the heart muscle. HCM usually causes only one side of the heart to thicken, making the heart pump unevenly.

There are three main types of cardiomyopathy:

  • Dilated
  • Hypertrophic—can be divided into two types:
    • Hypertrophic obstructive cardiomyopathy (HOCM)—the muscle between the two valves of the heart becomes so enlarged that it obstructs the blood flow in the heart
    • Non-obstructive hypertrophic cardiomyopathy—non-obstructive form, the enlarged muscle is not large enough to block blood flow
  • Restrictive

HCM can occur in people of all ages. But, it is usually most severe when it occurs in younger people.

Those with HCM are at an increased risk of sudden death. However, many individuals with HCM live a normal, healthy life with very few symptoms.

Hypertrophic Heart

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© 2008 Nucleus Medical Art, Inc.

Causes

Causes of HCM include:

  • An inherited gene that causes the abnormality
  • A defective gene that controls growth of the heart muscle
  • A viral infection

In people over age 60, HCM is likely to be caused by or related to high blood pressure .

Risk Factors

These factors increase your chance of developing this condition. Tell your doctor if you have any of these risk factors:

  • Having a family member with HCM
  • Being over age 60 and having hypertension

Symptoms

Symptoms include:

  • Chest pain
  • Fainting, particularly during exercise
  • Dizziness or lightheadedness, particularly following exercise
  • Heart palpitations
  • Shortness of breath or difficulty breathing
  • General fatigue
  • Tiring easily during exercise or activity
  • Shortness of breath when lying down

These symptoms can be caused by some of the side effects of the condition, including arrhythmias (abnormal heartbeats). The blocked or reduced blood flow is usually the cause of symptoms like dizziness, fainting, and difficulty breathing.

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam.

Tests may include the following:

  • Echocardiography—uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart
  • Transesophogeal echocardiogram—images of the heart are taken to detect abnormalities
  • Heart monitor—a portable electrocardiogram (ECG) records continuous heart activity usually over a 24-72 hour period to determine regularity of the heartbeat
  • Heart catheter—a catheter is inserted into an artery in the groin area and threaded to the heart chambers
    • An x-ray machine shows real-time images of your body as a dye is injected through the catheter. This allows angiograms (photos) to be taken of the blood vessels and the heart.
  • Blood tests
  • Chest x-ray—uses radiation to take a picture of structures inside the body, especially bones.

Treatment

Treatment focuses on controlling symptoms and preventing complications. Talk with your doctor about the best treatment plan for you. Treatment options include:

Medications

Medications may be used to help maintain proper and regular heart function. These may include beta-blockers and calcium channel blockers.

If you have an arrhythmia, you may need anti-arrhythmic drugs. You may also need blood-thinning medication.

Surgery

The thickened portion of the heart muscle is cut and removed. This may be needed if you have a severely blocked blood flow from the heart.

If the mitral valve is leaking, surgery may also be done to repair or replace the mitral valve.

Alcohol Septal Ablation

Alcohol is injected into the arteries of the thickened portion of the heart. This helps to reduce the blockage in the heart and improve blood flow out of the heart.

Implantable Cardioverter Defibrillators (ICD)

This ICD is implanted if you are at heightened risk for sudden death.

Prevention

To help reduce your chance of getting HCM, take the following steps:

  • If you have a family member who has been diagnosed with HCM—you and other family members should be screened for the condition
  • If family history puts you at higher risk for HCM—regular echocardiograms may reduce the risk of death or complications from HCM
  • If you have high blood pressure—take medications and follow other instructions as directed by your physician.

CANADIAN RESOURCES:

Canadian Cardiovascular Society
http://www.ccs.ca/home/index_e.aspx

Heart and Stroke Foundation of Canada
http://ww2.heartandstroke.ca/Page.asp?PageID=24

References:

Cardiomyopathy. The American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4468 . Accessed June 26, 2007.

Cardiomyopathy. EBSCO DynaMed website. Available at: http://dynamed102.ebscohost.com/Detail.aspx?id=115426 . Accessed June 26, 2007.

Erwin JP, Nishimura RA, et al. Dual chamber pacing for patients with hypertrophic obstructive cardiomyopathy: a clinical perspective in 2000. Mayo Clin Proc. 2000;75:173-180.

The HCM Program. St. Luke's Roosevelt Hospital Center website. Available at: http://www.hcmny.org/whatis/index.html . Accessed June 26, 2007.

Hypertrophic cardiomyopathy. The Cleveland Clinic Heart and Vascular Institute website. Available at: http://www.clevelandclinic.org/heartcenter/pub/guide/disease/hcm/default.htm . Accessed June 26, 2007.

Hypertrophic cardiomyopathy. Medline Plus Medical Encyclopedia. US National Library of Medicine website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000192.htm . Accessed June 26, 2007.

Maron BJ, Nishimura RA, McKenna WJ, et al. Assessment of permanent dual chamber pacing for patients with hypertrophic cardiomyopathy. Circulation . 1999;99:2927-2933.

McCully RB, Nishimura RA, Tajik AJ, Schaff HV, Danielson GK. Extent of clinical improvement after surgical treatment of hypertrophic obstructive cardiomyopathy. Circulation . 1996;94:467-471.



Last reviewed April 2008 by Michael J. Fucci, DO

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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