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AHN Hypertrophic Cardiomyopathy (HCM)

What is hypertrophic cardiomyopathy? 

Hypertrophic cardiomyopathy (HCM) is sometimes known as hypertrophic obstructive cardiomyopathy (HOCM) or idiopathic hypertrophic subaortic stenosis (IHSS). It is a condition where the heart’s walls become abnormally thickened and, as a result, the heart is no longer able to do its job as efficiently.  

In most cases, HCM is a genetic or inherited type of heart disease. Though patients rarely have thickening at birth, they are often born with the genetic instructions that encourage their heart to thicken abnormally over the course of their lifetime. For a small subset of patients with this condition, it can even lead to sudden cardiac death. HCM can be diagnosed at any age, but typically symptoms develop by middle age.

AHN is prepared to diagnose and treat people with hypertrophic cardiomyopathy, giving them the ability to lead a normal life once again.

"In general, hypertrophic cardiomyopathy is genetically linked. As we know now, there are several genes that are linked to this disease. But it does not always run through families." 

Pietro Bajona, MD, PhD - Director of Hypertrophic Cardiomyopathy Program

Hypertrophic cardiomyopathy symptoms

While many HCM patients do not experience any symptoms from this thickening of the heart muscle, others may experience one or more of the following: 

  • Chest pain, often during physical exertion, especially during quick bursts of activity or heavy lifting
  • Shortness of breath with physical exertion
  • Swelling in the ankles, feet, legs, abdomen, and veins in the neck
  • Palpitations
  • Arrhythmias or abnormal heart rhythms
  • Fatigue
  • Dizziness
  • Lightheadedness
  • Fainting

Hypertrophic cardiomyopathy care at AHN: Why choose us?

At the AHN Cardiovascular Institute, experienced and dedicated specialists provide support that you can depend on; they are subspecialty-trained providers with access to the latest diagnostic techniques and treatments, including both
medical and surgical interventions. Patients with HCM have access to expert cardiology providers who specialize in comprehensive cardiomyopathy care and imaging. 

How we diagnose hypertrophic cardiomyopathy 

Echocardiogram HCM diagnosis

The most common way to diagnose HCM is through an echocardiogram (also known as an “echo” or “TTE”), which is an ultrasound of the heart. This is a noninvasive, painless imaging test that uses sound waves to generate a picture of your heart and valves to determine how efficiently they are working.  

Electrocardiogram (ECG/EKG) HCM diagnosis

In some cases, an electrocardiogram (ECG/EKG) can detect unusual thickening of the heart muscle and/or abnormal heart rhythms that may be a sign of underlying HCM. 

Genetic testing

HCM is typically an inherited heart condition, with a 50% chance of being passed on to the next generation.* Most importantly, inheriting this condition from a parent carries a risk of developing HCM. A relative who carries an HCM mutation must be monitored over time with doctor visits and noninvasive imaging to detect any subtle signs of HCM appearing. Commercial testing is now available to identify the presence of a common genetic mutation as the cause of HCM. This test is performed by providing a saliva sample or, if preferred, by a blood test. It is sent to the lab for processing with results returning in three to four weeks. 

Treadmill stress test (often paired with echocardiogram)

This test monitors a patient’s response to physical activity and provides valuable information about changes in symptoms, heart rate, and blood pressure with exercise. It is always paired with continuous EKG monitoring to assess for abnormal heart rhythms during exercise. Most often, it is also paired with an echocardiogram to demonstrate visually how the heart and valves respond to exercise.  

Holter monitoring

This test records the electrical activity of the heart over time, ranging from 24 hours to several weeks. It can help detect abnormal heart rhythms that may contribute to symptoms.

Cardiac MRI 

This sophisticated imaging of the heart provides additional information beyond that of an echocardiogram to guide treatment and prognosis. In addition to
identifying classic anatomic features of HCM, or even conditions that mimic HCM, it also helps identify some patients with higher-risk features for abnormal heart rhythms relating to the condition. Learn more from the American Journal of Roentgenology about using MRI for HCM.

AHN Hypertrophic Cardiomyopathy Program

Learn about our team-based approach to diagnosing and care for your HCM.

"The first line of treatment for hypertrophic cardiomyopathy is medication. The good news for patients is that the vast majority of the time, it works. And that's all they need."

Pietro Bajona, MD, PhD - Director of Hypertrophic Cardiomyopathy Program

How we treat hypertrophic cardiomyopathy

The goal of any treatment is to relieve symptoms, protect those at higher risk of abnormal heart rhythms, and identify family members who warrant regular monitoring. Treatment may include: 

HCM medications

Medications can help to maximize the efficiency of a thickened heart muscle and commonly include:  

  • Beta blockers: Lopressor or Toprol XL (most commonly used).  Sometimes propranolol (Inderal) or atenolol (Tenormin) can be used as well.
  • Calcium channel blockers: Diltiazem (Cardizem, Tiazac) or Verapamil (Verelan, Calan SR).
  • Additional medications to help the heart’s efficiency: Disopyramide (Norpace), Mavacamten
  • Heart rhythm drugs: Amiodarone and Mexiletine
  • Blood thinners: Warfarin (Coumadin, Jantoven), Dabigatran (Pradaxa), Rivaroxaban (Xarelto) or Apixaban (Eliquis) to prevent blood clots in patients with atrial fibrillation, which is common with HCM.

HCM septal reduction therapies

If medication alone isn’t enough to fully treat your condition, AHN provides dedicated care with our surgeon and interventional cardiologists who are experienced at performing procedures that can thin your heart’s walls. AHN electrophysiologists can also implant small devices called defibrillators (also known as ICDs) that monitor your heart’s rhythm and can immediately recognize and treat a life-threatening rhythm if one were to occur.  

Read how we’ve maintained a gold standard of surgical outcomes for septal
myectomies
.

Contact us

Call (412) 359-4869 to speak with an HCM coordinator and make an appointment.