Diagnosis

To diagnose hypertropic cardiomyopathy (HCM), a healthcare professional examines you and listens to your heart with a device called a stethoscope. The device may help your healthcare professional hear a heart murmur while listening to the heart.

A member of your healthcare team usually asks questions about your symptoms and your medical and family history.

Tests

Healthcare professionals do tests to check the heart and look for causes of any symptoms.

  • Echocardiogram. This imaging test often is used to diagnose hypertrophic cardiomyopathy. It uses sound waves to make images of the beating heart. An echocardiogram shows how well the heart's chambers and valves are pumping blood. It also can see if the heart's muscle is thicker than it should be.
  • Electrocardiogram (ECG or EKG). This quick and painless test shows how the heart is beating. Sticky patches with sensors on them called electrodes go on the chest and sometimes the arms and legs. Wires connect the electrodes to a computer, which prints or shows the test results. An ECG can show irregular heartbeats and signs of heart thickening.
  • Holter monitor. This small, portable ECG device records the heart's activity. It's worn for a day or two while you do your regular activities.
  • Cardiac MRI. This test uses powerful magnets and radio waves to create images of the heart. It gives details about the heart muscle and how the heart and heart valves work. This test often is done with an echocardiogram.
  • Stress test. A stress test often involves walking on a treadmill or riding a stationary bike while a healthcare professional watches your heart activity. Exercise stress tests help reveal how the heart responds to physical activity.
  • Genetic testing or counseling. Hypertrophic cardiomyopathy usually is passed down in families. Ask your healthcare professional if genetic testing is right for you.
  • Cardiac CT scan. Rarely, this test is done to diagnose hypertropic cardiomyopathy. But it may be suggested if an MRI can't be used. A cardiac CT scan uses X-rays to make pictures of the heart and chest. It can show the size of the heart.

Treatment

The goals of hypertrophic cardiomyopathy (HCM) treatment are to relieve symptoms and prevent sudden cardiac death in people at high risk. Treatment depends on how bad the symptoms are.

If you have cardiomyopathy and are pregnant or thinking about pregnancy, talk with your healthcare professional. You might be sent to a doctor with experience in high-risk pregnancies. This doctor might be a perinatologist or a maternal-fetal medicine specialist.

Medications

Medicines can help reduce how strongly the heart muscle squeezes and slow the heart rate. That way, the heart can pump blood better. Medicines to treat hypertrophic cardiomyopathy and its symptoms might include:

  • Beta blockers such as metoprolol (Lopressor, Toprol-XL), propranolol (Inderal LA, Innopran XL) or atenolol (Tenormin).
  • Calcium channel blockers such as verapamil (Verelan) or diltiazem (Cardizem, Tiazac, others).
  • A medicine called mavacamten (Camzyos) that reduces the strain on the heart. It can treat obstructive HCM in adults with symptoms. Your healthcare team may suggest this medicine if you can't take or don't get better with beta blockers or verapamil.
  • Heart rhythm medicines such as amiodarone (Pacerone) or disopyramide (Norpace).
  • Blood thinners such as warfarin (Jantoven), dabigatran (Pradaxa), rivaroxaban (Xarelto) or apixaban (Eliquis). Blood thinners can help prevent blood clots if you have atrial fibrillation or the apical type of hypertrophic cardiomyopathy. Apical HCM can raise the risk of sudden cardiac death.

Surgeries or other procedures

Surgeries and other treatments are available to treat cardiomyopathy or its symptoms. They include:

  • Septal myectomy. This open-heart surgery might be suggested if medicines don't make symptoms better. The surgeon removes part of the thickened, overgrown wall between the heart chambers. This wall is called the septum. Septal myectomy helps improve blood flow out of the heart. It also helps treat a complication of HCM called mitral valve regurgitation.

    The surgery can be done using different methods, depending on the location of the thickened heart muscle. In one type, called apical myectomy, surgeons remove thickened heart muscle from near the tip of the heart. Sometimes the mitral valve is repaired at the same time.

  • Septal ablation. This treatment uses alcohol to shrink the thickened heart muscle. A heart doctor places a long, thin tube called a catheter into an artery that supplies blood to the affected area. Alcohol flows through the tube. Changes in the heart's electrical signaling system, also called a heart block, are a possible complication of this treatment. A heart block must be treated with a pacemaker. This small device is placed in the chest to help control the heartbeat.
  • Implantable cardioverter-defibrillator (ICD). A heart doctor places this device under the skin near the collarbone. It continuously checks the heartbeat. If the device finds an irregular heartbeat, it sends out low- or higher-energy shocks to reset the heart's rhythm. Use of an ICD has been shown to help prevent sudden cardiac death, which is the swift and not expected ending of all heart activity. Sudden cardiac death happens in a small number of people with hypertrophic cardiomyopathy.
  • Cardiac resynchronization therapy (CRT) device. Rarely, this implanted device is used as a treatment for hypertrophic cardiomyopathy. It can help the chambers of the heart squeeze in a way that's more organized and efficient.
  • Ventricular assist device (VAD). This implanted device also is rarely used to treat hypertrophic cardiomyopathy. It helps blood flow through the heart.
  • Heart transplant. This is surgery to replace a diseased heart with a donor's healthy heart. It can be a treatment option for end-stage heart failure when medicines and other treatments no longer work.

Lifestyle and home remedies

Lifestyle changes can lower the risk of complications related to hypertrophic cardiomyopathy. Try these healthy habits:

  • Exercise. Staying active keeps the heart healthy. Talk with your healthcare team about the amount and type of exercise that's best for you.
  • Eat a healthy diet. Eat plenty of fruits, vegetables and whole grains. Limit sugar, salt and saturated fats.
  • Don't smoke. Smoking is a major risk factor for heart disease. If you smoke and can't quit, talk with your healthcare team about programs or treatments that can help.
  • Stay at a healthy weight. Being overweight strains the heart and increases the risk of heart disease. Ask your healthcare professional what weight is best for you.
  • Limit or stay away from alcohol. Sometimes, irregular heartbeats and blocked blood flow are triggered or made worse by alcohol use. Ask your healthcare professional how much alcohol, if any, is safe for you to drink. Keep in mind that all types of heavy drinking are linked to worse heart health. That includes binge drinking, which means having four or more drinks for women, or five or more drinks for men, within about two hours.
  • Manage blood pressure and cholesterol. High blood pressure and high cholesterol raise the risk of heart disease. Make lifestyle changes and take medicines as directed to manage either condition. Get regular health checkups. Your healthcare professional might recommend regular follow-up appointments to check on your condition. Tell your care team if you have new symptoms or if your symptoms become worse.
  • Practice good sleep habits. Poor sleep may raise the risk of heart disease and other long-term conditions. Adults should try to get 7 to 9 hours of sleep daily. Go to bed and wake at the same time every day, including on weekends. If you have trouble sleeping, talk to a healthcare professional about treatments or changes that might help.

Coping and support

Connect with friends and family or a support group. You may find that talking about hypertrophic cardiomyopathy with other people who have heart conditions can help.

It's also important to manage your stress. Some good ways to do that are to get more exercise and practice mindfulness. If you have anxiety or depression, talk to your healthcare team about treatments that can help.

Preparing for your appointment

You may be referred to a doctor trained in heart diseases, called a cardiologist. Here's some information to help you prepare for your appointment.

What you can do

When you make the appointment, ask if you need to follow any restrictions before the checkup. For instance, you may need to change your activity level or your diet. Make a list of:

  • Your symptoms and when they began.
  • All medicines, vitamins and supplements you take, including doses.
  • Important medical information, including other conditions you have and any family history of heart disease.
  • Questions to ask your healthcare professional.

Questions to ask your healthcare professional might include:

  • What's the most likely cause of my symptoms?
  • What tests do I need?
  • What treatments can help?
  • What risks does my heart condition create?
  • How often do I need health checkups?
  • Do I need to change my activities?
  • What's an appropriate level of physical activity?
  • Should my children or other first-degree relatives be screened for this condition, and should I meet with a genetic counselor?
  • I have other health conditions. How do I manage them together?

Feel free to ask other questions you have.

What to expect from your doctor

Your healthcare professional is likely to ask you questions such as:

  • How bad are your symptoms?
  • Have your symptoms changed over time? If so, how?
  • Does exercise or physical activity make your symptoms worse?
  • Have you ever fainted?

What you can do in the meantime

Before your appointment, ask your family members if any relatives have been diagnosed with hypertrophic cardiomyopathy or have died suddenly without a clear cause.

If exercise makes your symptoms worse, don't do strenuous exercise until you have seen your healthcare professional. Ask for specific exercise recommendations.

By Mayo Clinic Staff