Hypertrophic cardiomyopathy

Diagnosis

The diagnosis of hypertrophic cardiomyopathy often involves asking questions about the symptoms, and one’s personal and family’s medical history. A physical exam will be conducted to check the heart and lungs. A cardiac murmur may be heard in people with hypertrophic obstructive cardiomyopathy (HOCM).

• Tests: Several tests may be required to confirm the diagnosis and to rule out other diseases that mimic the symptoms of HCM, such as:
  • Echocardiogram: This test indicates how efficiently the heart’s chambers and valves pump blood. It uses sound waves to determine whether the heart muscle is unusually thick. Echocardiography is frequently performed to diagnose hypertrophic cardiomyopathy.
  • Heart MRI: This test can show many elements of the heart, including chambers, valves, and muscles and how well they perform, as well as how the blood flows. This scans the heart using radio waves and magnets that generate 2D and 3D images which allow the doctor to make a diagnosis.
  • Electrocardiogram (ECG or EKG): An ECG can detect abnormal heartbeats as well as signs of cardiac thickening. It monitors, tracks, and records the electrical activity of the heart using temporary electrodes on the chest and limbs.
  • Holter monitor: This is a portable ECG device that can be worn for a day or longer to record the heart’s activity. This can be carried in a pocket or worn on a belt or shoulder strap during regular daily activities.
  • Stress test: This test is done while being active. Exercise testing can show how the heart reacts to physical exertion. Normally, the ECG is performed while riding a stationary bicycle or walking on a treadmill, to monitor the activity of the heart.
  • Cardiac catheterization: During this procedure, a catheter or a small tube is inserted into a blood artery in the arm or groin and then into the coronary arteries. This invasive imaging technique allows the doctor to assess the function of the heart.

Treatment

The treatment of hypertrophic cardiomyopathy is determined by several factors such as the patient’s symptoms, age, level of activity, degree of arrhythmia, how well the heart is working, and if there is an outflow tract. The goal of the treatment is to lessen or eliminate symptoms and the risk of consequences like heart failure and sudden cardiac death.

• Medications: Medication is frequently prescribed to alleviate the symptoms and avoid potential issues. Medications can assist in lessening the strength with which the heart muscle squeezes and slow the heart rate, allowing the heart to pump blood more efficiently.

These medications include:

• • Beta blockers: such as metoprolol, and calcium channel blockers such as verapamil. These drugs relax the heart muscle, allowing it to fill more efficiently and pump more effectively.
  • Heart rhythm medications: such as amiodarone or disopyramide. These drugs may help manage the heart rate or reduce the frequency of arrhythmias.
  • Blood thinners: such as warfarin, dabigatran, rivaroxaban or apixaban may be prescribed. These medications may help minimize the risk of sudden cardiac death due to blood clots related to atrial fibrillation or apical hypertrophic cardiomyopathy.
• Surgeries or other procedures: Procedures for treatment of hypertrophic cardiomyopathy include:
  • Septal myectomy: Depending on the location of the thickened heart muscle, the procedure can be performed in a variety of ways. One kind, known as apical myectomy, involves the removal of thickened cardiac muscle around the tip of the heart. The mitral valve is sometimes repaired at the same time.

Septal myectomy involves removing a little portion of the thickened septal wall to widen the path the blood takes (outflow tract) from the left ventricle to the aorta. It improves blood flow out of the heart and decreases backward flow through the mitral valve. This is often suggested if medication fails to alleviate symptoms.

• • Septal ablation: This surgery is designated for patients who are unable to undergo a septal myectomy. Complications could include a disturbance of the heart’s electrical system or heart block, which necessitates the insertion of a pacemaker.

During the procedure, a balloon catheter is placed and inflated into the artery. The contrast agent is then injected to find the thicker septal wall that narrows the passageway from the left ventricle to the aorta. When the doctor finds the bulge, he or she will inject a small amount of pure alcohol through the catheter. The alcohol destroys the cells on touch, causing your septum to shrink back to normal size over time. This widens the blood flow route.

• • Implantable cardioverter-defibrillator (ICD): People who are at risk of life-threatening arrhythmias or abrupt cardiac death can benefit from ICDs. The ICD is a tiny device that is inserted just beneath the skin and is linked to wire leads that are threaded through a vein to the heart. If a potentially fatal arrhythmia occurs, the ICD delivers precisely calibrated electrical shocks to restore cardiac rhythm.

Most cases of women with hypertrophic cardiomyopathy can support their pregnancy and give birth vaginally. However, these pregnancies often require specialized treatment and careful monitoring. Women who are considering becoming pregnant may consult a doctor who specializes in caring for women with high-risk pregnancies for proper care. In some cases, hypertrophic cardiomyopathy medications may be prescribed during pregnancy.