Hypertrophic Cardiomyopathy

Topic Overview

What is hypertrophic cardiomyopathy?

Hypertrophic cardiomyopathy (say "hy-per-TROH-fik kar-dee-oh-my-AWP-uh-thee") happens when the heart muscle grows too thick, so the heart gets bigger and its chambers get smaller. Many people have no symptoms and live a normal life with few problems. But in some people with this condition:

• The heart doesn't get enough blood and oxygen, which can cause chest pain.
• A fast, slow, or uneven heartbeat (arrhythmia) develops. In rare cases, this can cause sudden death.
• The heart doesn't pump blood well, or it doesn't relax between beats as it should. In rare cases, this can lead to heart failure.

People who exercise often and hard may have changes in their heart muscle that can be confused with hypertrophic cardiomyopathy. This condition is called athlete's heart syndrome. It is harmless. When an athlete stops training, the heart will return to a normal size.

What causes hypertrophic cardiomyopathy?

Certain genes cause the heart to grow more than it should.

Hypertrophic cardiomyopathy is the most common genetic disease of the heart. This means it runs in families. About 1 in 500 adults has this condition.^{footnote 1}

You are at risk for hypertrophic cardiomyopathy if either of your parents or a brother or sister has it or died suddenly at a young age. Talk to your doctor about getting tested.

What are the symptoms?

You may not have any symptoms. Or you might:

• Feel tired and short of breath when you are active.
• Have chest pain. You may have a heavy, tight feeling in your chest. Chest pain is often brought on by exercise, when the heart has to work harder.
• Feel dizzy or faint, often after you have been active.
• Feel like your heart is pounding, racing, or beating unevenly (palpitations).

A rapid or irregular heartbeat or fainting spells are signs of an arrhythmia, which makes sudden death more likely.

How is hypertrophic cardiomyopathy diagnosed?

Your doctor will do a physical exam and ask you about any health problems you've had and about any family history of heart disease or early and sudden death. You may need tests such as:

• Echocardiogram.
• Electrocardiogram (ECG or EKG).
• Chest X-ray.
• MRI.

Your doctor may refer you to a doctor who specializes in heart problems (cardiologist). Based on your symptoms, past health, and family history, the specialist can assess your risk for sudden death. People who are at high risk will need regular checkups. If you are at low risk for sudden death, you may not need to see your doctor often. But you will need a checkup anytime your symptoms change or get worse.

How is it treated?

Many people who have hypertrophic cardiomyopathy don't have symptoms and don't need treatment. If you do have symptoms, your treatment will depend on what your symptoms are and whether you develop heart failure or an abnormal heart rhythm.

• You may take medicines to treat symptoms such as shortness of breath and chest pain.
• If you get a serious heart rhythm problem such as atrial fibrillation, you may take medicines to control your heart rate or rhythm and to prevent blood clots.
• If you are at high risk for sudden death from an arrhythmia, you may need an implantable cardioverter-defibrillator (ICD). An ICD is a small device like a pacemaker. It can prevent or stop dangerous heart rhythms.
• If medicines don't work and your heart isn't pumping blood well, you might have a procedure to reduce the size of the overgrown part of your heart. The overgrown part can be removed with a surgery called myectomy. Or it can be destroyed by injecting alcohol into the artery that supplies that part of the heart. This procedure is called nonsurgical septal reduction, or alcohol septal ablation.

What can you do at home for hypertrophic cardiomyopathy?

• Avoid strenuous activity and intense exercise. Your doctor can tell you what level of exercise and what kinds of activities are safe for you.
• Be active at a safe level to help keep your heart and body healthy.
• If you smoke, quit. Your doctor can tell you about medicines and counseling that can help you quit for good.
• Drink plenty of fluids (unless your doctor has told you to limit your fluid intake).
• Get checkups as often as your doctor recommends.