Many people with hypertrophic cardiomyopathy do not need treatment. But in some cases, having a thickened heart muscle can cause problems. If symptoms develop, treatment is usually recommended. Medicines cannot cure hypertrophic cardiomyopathy, but they may be used to treat complications, including Reference atrial fibrillation Opens New Window and Reference heart failure Opens New Window. These medicines include:
- Beta-blockers. Beta-blockers are often used to treat people who develop symptoms such as shortness of breath or chest pain. They lower blood pressure, slow heart rate, and improve blood flow, which helps decrease symptoms and improves your ability to exercise. They may even prevent or delay the progression of heart failure related to hypertrophic cardiomyopathy.
- Reference Calcium channel blockers. Calcium channel blockers are used to help relieve symptoms, especially chest pain. These medicines also slow heart rate and lower blood pressure.
- Reference Antiarrhythmic medicines Opens New Window. These medicines are used to control the heart rhythm. One example is disopyramide (Norpace). An antiarrhythmic medicine might be used if you also have atrial fibrillation.
Reference Atrial fibrillation Opens New Window occurs in about 1 out of 4 people who have hypertrophic cardiomyopathy. In atrial fibrillation, abnormal electrical impulses cause the upper chambers of the heart (atria) to fibrillate, or quiver, resulting in irregular and rapid beating of the ventricles, the heart's main pump. For most people, this aspect of atrial fibrillation in itself is usually not life-threatening. But for people who have hypertrophic cardiomyopathy, atrial fibrillation can increase your risk for other abnormal heart rhythms that can be life-threatening. It also increases your risk for heart failure and stroke. For these reasons, most doctors aggressively treat atrial fibrillation in people who have hypertrophic cardiomyopathy. Aggressive treatment may include medicines to control the heart rate or rhythm, Reference electrical cardioversion Opens New Window to return the heart to its normal rhythm, or catheter ablation or surgery to destroy heart tissue that is causing atrial fibrillation. For more information, see the topic Reference Atrial Fibrillation.
Reference Anticoagulants Opens New Window often are prescribed for people who have atrial fibrillation. Anticoagulants help protect against blood clots that develop in the heart. Blood clots can be dangerous because they may break loose and travel through the bloodstream (thromboembolism), which may cause a stroke, heart attack, or blocked blood flow to an arm or leg.
Most people who have hypertrophic cardiomyopathy should be assessed by a cardiologist to find out their risk for Reference ventricular tachycardia, an abnormally fast heart rate that can result in sudden death. For those in a Reference high-risk category, an Reference implantable cardioverter-defibrillator (ICD) appears to be the most effective treatment for preventing sudden death.
Because of the risk of sudden death, it is important for people who have hypertrophic cardiomyopathy to avoid too much strenuous activity and intense exercise. Talk to your doctor about what level of exercise and what kinds of activities are safe. Prolonged activity in hot weather is not recommended, because dehydration can also make symptoms worse in people who have hypertrophic cardiomyopathy.
It is important for people with high-risk hypertrophic cardiomyopathy to have frequent check-ups with their doctors. People who are low-risk may not see their doctors as often. But you may see the doctor more often if you have a change in your symptoms or your overall health. When symptoms appear or start to get worse, a check-up might include an Reference echocardiogram Opens New Window (echo), Reference electrocardiogram Opens New Window (ECG, EKG), or exercise test. Your doctor will talk about your symptoms and your health history. You may also talk about the health history of people in your family. These regular visits will help your doctor identify things that may put you at risk for sudden cardiac death and other serious medical conditions.
If symptoms develop, treatment is usually recommended. Medicines cannot cure hypertrophic cardiomyopathy, but they may be used to treat complications, including Reference atrial fibrillation Opens New Window and Reference heart failure Opens New Window. After medicines are started, most people need to take them for the rest of their lives.
Treatment if the condition gets worse
If you have serious heart rhythm problems or are at high risk for sudden death, your doctor might recommend an Reference implantable cardioverter-defibrillator (ICD).
Medicines for heart failure may be used if hypertrophic cardiomyopathy progresses to that advanced state. For more information, see the topic Reference Heart Failure.
A surgery called a myectomy or myomectomy may be advised for some people when medicines do not help relieve severe symptoms of heart failure (Reference NYHA class III and IV) due to hypertrophic cardiomyopathy. In this surgery, a portion of overgrown heart muscle is removed. Often the excess muscle tissue is found in the septum, which divides the left and right lower heart chambers (ventricles). An overgrown septum can interfere with the function of the left ventricle and limit blood flow out of the heart. Most people who have this surgery recover well and end up with fewer symptoms. After surgery, physical activity is easier too.
Another option for people who have hypertrophic cardiomyopathy is nonsurgical septal reduction, also called alcohol septal ablation. When the area of the heart muscle that divides the right and left chambers (septum) becomes too thick, the lower left heart chamber (left ventricle) becomes obstructed, which hinders its ability to pump normally. The thickened septum is reduced in size by injecting alcohol into the coronary artery that supplies this area of the heart with blood. The alcohol destroys some of the heart muscle in the thickened septum. This reduces the obstruction and improves the left ventricle's pumping ability. Advantages of this procedure are that major surgery and lengthy recovery are avoided because the alcohol can be given through a catheter during a Reference cardiac catheterization Opens New Window procedure. This procedure can help relieve symptoms. But it is a newer procedure, so the long-term effects are not yet known. Experts recommend that this complex procedure be done in a large medical center where the staff has substantial experience with it.
|By:||Reference Healthwise Staff||Last Revised: Reference July 23, 2012|
|Medical Review:||Reference Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
Reference Robert A. Kloner, MD, PhD - Cardiology
Reference George Philippides, MD - Cardiology