Harry Lever, MD

Tuesday, October 3, 2017 | Noon


Hypertrophic cardiomyopathy (HCM) is a complex type of heart disease that causes thickening of the heart muscle (especially the ventricles, or lower heart chambers), left ventricular stiffness, mitral valve and cellular changes. Harry Lever, MD, Director of the Cleveland Clinic Hypertrophic Cardiomyopathy Center answers your questions about HCM.

More Information

Our chat on 10/3/2017 was cancelled due to technical difficulties. However Dr. Lever answered the following questions that were sent in by participants:

Symptoms of HCM

Q. How common is crushing pain in left arm as a symptom of HCM? [maybe could elaborate on symptoms of HCM]

Dr. Lever: The most common symptoms is shortness of breath but you can also get chest pain – if the symptoms are associated with exertion, then we also need to rule out coronary artery disease (CAD). Only 20% of patients with HCM have CAD. Left arm pain is not a common symptom of HCM, however if it is associated with exertion, it then needs to be looked at further as a cad problem.

Q. Sorry that the web conference could not happen: I was diagnosed in 2011 (right side of heart). (Pacemaker inserted at end of 2010) I am a runner and have ran for 40 years, in the last 2 years, my energy level has suffered greatly and my running has slowed down significantly. Doctors do not think it is my heart, what is your opinion on this.

Dr. Lever: You need to be evaluated further for what is causing your symptoms.

Diagnosis of HCM

Q. Does Ejection fraction change for someone who has HCM. Mine is 65% is that normal?

Dr. Lever: That is a normal ejection fraction (EF). Part of being evaluated yearly is to watch for changes in EF.

Q. Is Systolic Heart Failure with EF of 45% and Mitral Valve Regurgitation considered HCM?

Dr. Lever: Not necessarily, unless the muscle is very thick.

Q. What tests are used to diagnose HCM? If I come to Cleveland Clinic, what can I expect during a HCM evaluation?

Dr. Lever: The following tests are used at Cleveland Clinic to evaluate HCM: Resting echocardiogram, stress echo, MRI, 48 hour holter monitor, EKG and chest x-ray are all used to diagnose HCM (Unless they have been done recently elsewhere).

Management of HCM

Q. Is WEIGHT CONTROL, BLOOD PRESSURE, and LIMITING FAT INTAKE for someone diagnosed with HCM important? If so, why? Thank you!

Dr. Lever: Yes – I think so – it is important for anybody. These are important parts of keeping your heart healthy.

Q. Are there any medicines that can heal HCM?

Dr. Lever: Not at this time.

Q. How often should you be seen by a doctor if you have HCM in your family? I had an echo 2 years ago with no signs of HCM.

Dr. Lever: A visit once a year with a cardiologist is good follow up.


Q. When do you suggest a myectomy?

Dr. Lever: When patients having severe symptoms with significant gradient at rest or with provocation (during a stress test) and the symptoms are shortness of breath, dizziness or chest pain.

Q. Is arm pain HCM symptom removed following myectomy?

Dr. Lever: If you are having it because of the HCM before surgery, usually it is gone after the myectomy.

Q. What is normal recovery from myectomy?

Dr. Lever: The time frame is variable – it depends on the person. You cannot drive a car for 6 weeks. Chest soreness can last several months. You will feel better because the operation fixed the heart and your symptoms should feel better – but there is chest wall healing that needs to occur – this can take time.

Q. What travel restrictions follow myectomy?

Dr. Lever: We have many patients who travel to the Cleveland Clinic for myectomy. If you are driving home from Cleveland Clinic, you will need to stop every 2 hours. If you fly – we recommend 2 hours on the ground in between flights (if you have stops). If the flight is over 2 hours in length, you need to walk every hour or so.

Q. What is normal follow up like after myectomy?

Dr. Lever: You will need to return at six weeks for an EXG, chest x-ray, echocardiogram and some blood work. Return to your HCM cardiologist yearly.