Hypertrophic Cardiomyopathy

Treatment

Comparison of a heart with HCM during relaxation and contraction

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At Mayo Clinic, cardiovascular specialists have expertise and experience in treating hypertrophic cardiomyopathy with the most current treatments available, including complex surgical procedures. Cardiologists, cardiac surgeons and geneticists work together to determine the most effective treatment for each patient. Mayo Clinic is one of the most experienced centers in the world in performing surgeries, including myectomies, to treat hypertrophic cardiomyopathy. Mayo Clinic's site in Minnesota offers an integrated team of specialists in its Hypertrophic Cardiomyopathy Clinic to provide diagnosis and treatment for patients with this condition.

Treatment for hypertrophic cardiomyopathy depends on the condition of the heart and the severity of symptoms. Care is intended to decrease stress on the heart and relieve symptoms. Treatment for hypertrophic cardiomyopathy at Mayo Clinic may include surgery, medical devices or medications. A physician may also recommend changes in diet and exercise as part of the treatment plan.

Myectomy (Surgery)

A heart with HCM before and during a myectomy

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Myectomy is the surgical removal of part of the overgrown septal muscle to decrease the outflow tract obstruction. Myectomy is open-heart surgery and should be done at an experienced medical center such as Mayo Clinic. Myectomy is performed when medication no longer relieves symptoms.

A successful operation has been shown to dramatically improve symptoms in over 90 percent of patients. Long-term outcomes have been excellent. Important research suggests that a subset of patients who have a myectomy live longer than they would have without the operation. For patients who have a myectomy, the survival rate at one year is 99 percent; at five years, 98 percent; and at 10 years, 95 percent. By comparison, the survival rate of patients who do not have a myectomy is 94 percent at one year; 89 percent at five years; and 73 percent at 10 years. Read more about myectomy results at Mayo Clinic.

Risks associated with open-heart surgery depend upon the patient's general health and age. However, in a young, otherwise healthy person, the overall risk of death at Mayo Clinic is less then 1 percent. At Mayo Clinic in Minnesota, more than 1,000 myectomy operations have been performed. Mayo Clinic is one of the most experienced centers in the world in performing myectomies.

Septal ablation procedure

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Septal Ablation

Septal ablation is a relatively new technique performed at Mayo Clinic during cardiac catherization. In septal ablation, an alcohol solution is injected into an artery supplying the part of the thickened muscle that causes the obstruction. The result of septal ablation is a localized myocardial infarction (a small controlled "heart attack") of this region of the heart muscle that decreases the degree of obstruction. Septal ablation can relieve the obstruction and improve symptoms if properly performed, but the long-term outcomes of this relatively new procedure are still unknown. Potential complications may include heart block, which would require a pacemaker.

While the septal ablation procedure is relatively new, a research study at Mayo Clinic suggests that this procedure has results close to those of surgical myectomy. However, long-term safety issues need to be resolved, and not all patients have heart anatomy that allows them to be candidates for septal ablation. Read more about this research study.

Automatic Defibrillator (AICD)

An automatic implantable defibrillator (AICD) might be recommended in some patients who are considered very high risk or to prevent sudden cardiac death. Important factors to consider for each patient include a drop in blood pressure during exercise, a family history of cardiac arrest, history of cardiac arrest, or unexplained fainting, life-threatening heart rhythms or severe heart muscle thickness. An implantable cardiac defibrillator is a small device used to monitor and to restore normal heart rhythm, similar to a pacemaker.

In this procedure, a small device is placed under the skin just below the collarbone and is connected to wire leads threaded through the vein into the heart chamber. The AICD monitors heart rhythms constantly. It can restore a normal heart rhythm using pacemaker functions or small electric shocks. Usually, implantation is done in the hospital and requires an overnight stay.

Pacemaker

Pacemakers have been used to relieve outflow tract obstruction in the heart that is caused by hypertrophic cardiomyopathy. But results from pacemaker usage have not been consistent. Generally, pacemakers do not provide the same degree of relief as other options. Pacemakers are now used only in special circumstances in the treatment of hypertrophic cardiomyopathy.

Medications

Medications help relax the heart and reduce the degree of obstruction so the heart can pump more efficiently. Beta-blockers and calcium channel blockers slow the heart rate, decrease contractions and relax the heart muscle. Anti-arrhythmia drugs decrease contractions to prevent abnormal rhythms and slow the heart rate.