Hypertrophic Cardiomyopathy

Conditions Basics

What is hypertrophic cardiomyopathy?

Hypertrophic cardiomyopathy (say "hy-per-TROH-fik kar-dee-oh-my-AWP-uh-thee"), or HCM, happens when the heart muscle grows too thick. 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:

• 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's harmless. When an athlete stops training, the heart will return to a normal size.

What causes it?

Hypertrophic cardiomyopathy is usually passed down through families. Certain genes cause the heart to grow more than it should. You're at risk for this condition if either of your parents or a sibling has it. 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).

How is it 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).
• Exercise stress testing.
• 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 hypertrophic cardiomyopathy treated?

Many people 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 a heart rhythm problem, an implantable cardioverter-defibrillator (ICD) may be an option. 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 reduced by injecting alcohol into the artery that supplies that part of the heart. This is called nonsurgical septal reduction, or alcohol septal ablation.

How can you care for yourself?

There are several things you can do to be safe and stay healthy when you have hypertrophic cardiomyopathy.

• Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
• If you smoke, vape, or use other tobacco or nicotine products, try to quit. If you can't quit, cut back as much as you can. If you need help quitting, talk to your doctor about quit programs and medicines. These can increase your chances of quitting for good.
• Eat heart-healthy foods. These include fruits, vegetables, whole grains, fish, and lean meats. Limit sodium, sugars, and alcohol.
• Drink plenty of fluids (unless your doctor has told you to limit your fluid intake).
• Be active at a safe level. Try to exercise on most, if not all, days of the week. Ask your doctor what level of exercise and what kinds of activities are safe for you. You may need to avoid strenuous activity.
• Stay at a weight that's healthy for you. Talk to your doctor if you need help losing weight.
• Manage other health conditions such as high blood pressure and high cholesterol.
• Get checkups as often as your doctor recommends.
• Avoid infections such as COVID-19, colds, and the flu. Get the flu vaccine every year. Get a pneumococcal vaccine. If you have had one before, ask your doctor whether you need another dose. Stay up to date on your COVID-19 vaccines.
• Tell your family members that you have hypertrophic cardiomyopathy. They may want to talk with a doctor about getting tested for this condition. Testing can identify it before it causes symptoms.