The type of HCM treatment prescribed depends on:
- Whether there is narrowing in the outflow tract (the path blood travels to leave the heart)
- How the heart is functioning
- The patient’s symptoms
- The age and activity level of the patient
- The presence of arrhythmias
Treatment is aimed at minimizing or preventing symptoms and reducing the risk of complications, such as heart failure and sudden cardiac death.
Treatment includes risk identification and regular follow-up, lifestyle changes, medications and procedures, as needed.
Screening and Risk Identification
Hypertrophic Cardiomyopathy (HCM) is a medical condition that may be passed on from generation to generation. It is important for you or your family members to have screening if you have a first-degree relative with the condition. First-degree relatives are your parents, siblings and children.
If the test results show signs of Hypertrophic Cardiomyopathy, you will need to see a cardiologist who specializes in HCM. For a list of Cleveland Clinic doctors who treat patients with this condition, visit our Hypertrophic Cardiomyopathy Center.
If your test results are normal, we suggest a follow up echo and EKG every three years until you are 30 years old, and then every 5 years thereafter.
Risk For Sudden Cardiac Death
Most people with HCM have a low risk for sudden cardiac death. However, it is important to identify the small number of patients with HCM who do have a higher risk for sudden cardiac death, so preventive measures can be taken.
People with HCM who have a higher risk for sudden cardiac death include:
- Patients who have a family history of sudden cardiac death
- Young patients who have had several episodes of syncope (fainting)
- Patients who experience an abnormal blood pressure response with exercise
- Patients who have a history of arrhythmia with a fast heart rate
- Patients with severe symptoms and poor heart function
Your doctor can discuss your personal risk. If you have two or more risk factors for sudden death, your doctor may prescribe preventive treatments such as antiarrhythmic medications or an implantable cardioverter defibrillator (ICD) to reduce your risk.
Medications are often prescribed to treat symptoms and prevent further complications. Medications such as beta-blockers and calcium channel blockers relax the heart muscle, allowing it to fill better and pump more effectively. Other medications may be prescribed as needed to control your heart rate or decrease the occurrence of arrhythmias.
You may be told to avoid certain medications, such as nitrates, because they lower blood pressure, or digoxin, because it increases the force of the heart’s contraction.
Antibiotic medications may be prescribed to reduce the risk of bacterial endocarditis, a potentially life-threatening condition (see other precautions listed on the next page).
Procedures for the treatment of hypertrophic obstructive cardiomyopathy include septal myectomy, ethanol ablation, implantable cardioverter defibrillator (ICD) and heart failure management, as needed.
During a septal myectomy, a surgical procedure, the surgeon removes a small amount of the thickened septal wall to widen the outflow tract (the path the blood takes) from the left ventricle to the aorta. Myectomy is considered when medications are not effective in treating HCM. This frequently eliminates the mitral valve regurgitation.
This procedure, also called septal ablation, is reserved for patients who are not eligible candidates for septal myectomy. The ablation procedure is performed in the cardiac catheterization laboratory.
First, the small coronary artery that supplies blood flow to the upper part of the septum is located during a cardiac catheterization procedure. A balloon catheter is inserted into the artery and inflated. A contrast agent is injected to locate the thickened septal wall that narrows the passageway from the left ventricle to the aorta.
When the bulge is located, a tiny amount of pure alcohol is injected through the catheter. The alcohol kills the cells on contact, causing the septum to shrink back to a more normal size over the following months, widening the passage for blood flow.
Implantable Cardioverter Defibrillators (ICD)
ICDs are suggested for people at risk for life-threatening arrhythmias or sudden cardiac death. The ICD is a small device placed just under the skin and is connected to wire leads that are threaded through the vein to the heart. An ICD constantly monitors the heart rhythm. When it detects a very fast, abnormal heart rhythm, it delivers energy (a small but powerful shock) to the heart muscle to cause the heart to beat in a normal rhythm again. Your doctor will tell you if an ICD is recommended.
Certain lifestyle changes, as listed below, are essential for properly managing HCM.
- Fluid and sodium restrictions may be necessary for some patients if heart failure symptoms are present. Ask your doctor for specific fluid and dietary guidelines, including information about alcoholic beverages and caffeinated products.
- Exercise. Your doctor will discuss exercise guidelines with you. Most people with hypertrophic cardiomyopathy are able to participate in noncompetitive aerobic activities. Heavy weight lifting and many high-intensity sports are not recommended.
- Regular Follow-Up Visits. Patients with HCM should follow up regularly with their cardiologist, as recommended, to monitor their condition.
- Reducing the Risk of Infection. See below about precautions to take if you are at risk of developing infective endocarditis.
Infective Endocarditis Precautions
If you have HCM, you have an increased risk of developing bacterial or infective endocarditis.
Bacterial or infective endocarditis is an infection of the heart valves or the heart’s inner lining (endocardium). It occurs when germs (especially bacteria, but occasionally fungi and other microbes) enter the blood stream and attack the lining of the heart or the heart valves. Bacterial endocarditis causes growths or holes on the valves or scarring of the valve tissue, most often resulting in a leaky heart valve. Without treatment, bacterial endocarditis can be a fatal disease.
To Reduce Your Risk
- Practice good oral hygiene habits every day. Take good care of your teeth and gums by seeking professional dental care every six months, regularly brushing and flossing your teeth, and making sure dentures fit properly.
- Call your doctor if you have symptoms of an infection, including a fever over 100 degrees F; sweats or chills; skin rash; pain, tenderness, redness or swelling; wound or cut that won’t heal; red, warm or draining wound; sore throat, scratchy throat or pain when swallowing; sinus drainage, nasal congestion, headaches or tenderness along upper cheekbones; persistent dry or moist cough that lasts more than two days; white patches in your mouth or on your tongue; nausea, vomiting or diarrhea.
- Don’t wait to seek treatment. Colds and the flu do not cause endocarditis, but infections, which may have the same symptoms, do cause endocarditis. To be safe, call your doctor.
- Cleveland Clinic cardiologists believe it is important for patients with HCM to take preventive antibiotics before certain medical and dental procedures, in addition to following the steps above to reduce your risk. Please talk to your doctor about the type and amount of antibiotics you should take, and for what procedures you should take them.
- A bacterial endocarditis identification card is available from the American Heart Association and should be carried with you. Ask your doctor for a card or go to www.americanheart.org and search for “bacterial endocarditis wallet card.”