Your Trusted Hypertrophic Cardiomyopathy (HOCM)Treatment and Prevention Experts In South Dakota
What is Hypertrophic Cardiomyopathy (HOCM)
One of the most common forms of congenital heart disease is hypertrophic cardiomyopathy (HCM), or hypertrophic obstructive cardiomyopathy (HOCM). HCM is abnormal thickening of the heart muscle, called hypertrophy. As the heart muscle thickens, it becomes stiff and is unable to pump blood or contract normally.
Symptoms of Hypertrophic Cardiomyopathy (HOCM)
The majority of people with HCM don’t realize they are affected, but some with moderate to severe thickening of the heart muscle may develop symptoms such as:
- Shortness of breath or chest pain, usually with exercise
- Dizziness or fainting, usually with exercise
- Irregular or fast heartbeat (palpitations)
Cause of Hypertrophic Cardiomyopathy (HOCM)
HCM is usually caused by genetic mutations. These inherited mutations cause abnormal thickening of the heart muscle, as well as irregular cell structure within heart muscle cells called myocytes. The resultant myofiber disarray may trigger abnormal heart rhythms and, rarely, sudden cardiac death.
As mentioned, HCM is an inherited heart problem and is passed down through families. If one of the parents is affected, each child has a 50% chance of having the gene that causes the disease (HCM). All first-degree relatives of the person with the disease (parents, brothers, sisters, children) should be screened for the disease.
Associated Problems of Hypertrophic Cardiomyopathy (HOCM)
If untreated or diagnosed later in life, hypertrophic cardiomyopathy (HCM) patients may develop the following conditions
Most commonly atrial fibrillation and atrial flutter (Hyperlink to atrial fibrillation). The thickened heart muscle with abnormal cell function can lead to an irregular heartbeat, shortness of breath, chest pain, and palpitations. You will likely need a blood thinner to prevent blood clots and stroke.
If your heart muscle becomes severely thickened, blood may not flow through the pumping chambers of the heart normally resulting in mitral valve regurgitation. The mitral valve may become leaky, and blood will flow backwards into the upper chamber of the heart. Often times this cause shortness of breath with mild physical activity.
In some patients with severe thickening (hypertrophy) of the heart, the heart muscle may become tired and weaken considerably. This is called dilated cardiomyopathy, or “burnt out” HCM. This may eventually result in severe symptoms, such as shortness of breath and fatigue.
Fainting, also called syncope, can sometimes occur in patients with HCM. If this occurs, notify your doctor immediately.
In very rare instances, in patients with severe thickening of the heart muscle sudden cardiac death may occur due to a potentially fatal abnormal heart rhythm. In younger patients, such as high school or college students, this may be the first sign of HCM.
Diagnosis of Hypertrophic Cardiomyopathy (HOCM)
A qualified cardiologist will ask you questions about your medical and family history and perform a thorough physical examination. If the diagnosis of HCM is suspected, a series of tests may be performed.
- Electrocardiogram (EKG)
- Heart rhythm monitor (Holter monitor)
- Echocardiogram
- Stress echocardiogram
- Cardiac MRI
- Brain MRA
- Blood testing (such as genetic testing, hsTroponin, NT-pro-BNP)
Treatment of Hypertrophic Cardiomyopathy (HOCM)
In patients with HCM or HOCM, the goal of treatment is to decrease symptoms, prevent sudden cardiac death in high-risk individuals, and possibly reverse heart muscle thickening with novel medication.
Beta blockers (such as metoprolol) and calcium channel blockers (such as verapamil) are the mainstay of medical therapy for HCM and HOCM. They slow the heart rate and help the heart muscle function more efficiently. Disopyramide (Norpace) is an anti-arrhythmic medicine used to slow the heart rate and help the heart muscle function more efficiently. Mavacamten (Camzyos) is a new medication that can be used to reduce heart muscle thickening and decrease symptoms of HOCM. Rivaroxaban (Xarelto) or Apixaban (Eliquis) will be required in patients with HCM or HOCM to reduce the risk of blood clots and stroke.
If the heart muscle is severely thickened and symptoms cannot be controlled with medicine, other therapeutic surgeries or procedures may be recommended.
- Alcohol Septal Ablation (ASA). This minimally invasive procedure is performed through the wrist by an interventional cardiologist. Alcohol (95% Ethanol) is injected into a small artery of the heart to shrink the thickened heart muscle and reduce or eliminate symptoms.
- Septal myectomy. Classically this is open-heart surgery where part of the thickened heart muscle is surgically removed. Both ASA and septal myectomy help improve blood flow inside the heart to reduce or eliminate symptoms.
- Implantable Cardioverter-Defibrillator (ICD). This device is implanted underneath the skin near collarbone. In a small number of patients at high risk of sudden cardiac death, or in patients who have survived an out-of-hospital cardiac arrest, this device continuously monitors the heart rhythm to treat and prevent sudden death.
No matter the severity of HCM or HOCM, it is important to find support. There are emotional support groups for patients and families to connect with and learn more about living with HCM.
- Exercise: Please ask your cardiologist about exercise. In patients with HCM and HOCM, there are recommended levels of exercise based on the severity of heart muscle thickening.
- Diet: A health diet is recommended, such as a diet rich in vegetables, fruits, and whole grains. Avoiding foods rich in fat and high in sugar is encouraged.
- Avoid alcohol: In some patients, consuming alcohol may trigger abnormal heart rhythms.
- Blood pressure: Maintaining adequate control of blood pressure is important to reduce the risk of other forms of heart and vascular disease.
- Sleep: The more we learn about sleep, the more we realize how important adequate sleep is to live a healthy life. In general, 8 hours of sleep is recommended to wake up feeling refreshed and ready to go.
- Stop smoking: If you smoke or use tobacco products, please ask about programs designed to help with smoking cessation.
Experienced Care for Hypertrophic Cardiomyopathy (HOCM) Symptoms in the Black Hills
If you or a loved one has been diagnosed with hypertrophic cardiomyopathy (HCM or HOCM), or if a family member has been diagnosed, please call Black Hills Heart and Vascular at (605) 503-8192 to schedule an appointment.
