A doctor holds a stethoscope to a patient's chest. An exam at Mayo Clinic

A healthcare professional listens to a person's heart at Mayo Clinic.

A healthcare professional examines you and listens to your heart with a device called a stethoscope. A heart murmur may be heard while listening to the heart.

A member of your healthcare team usually asks questions about your symptoms and your medical and family history. Genetic testing or counseling may be recommended if you have a family history of the condition.


Tests are done to check the heart and look for causes of any symptoms.

  • Echocardiogram. An echocardiogram often is used to diagnose hypertrophic cardiomyopathy. Sound waves are used to create images of the beating heart. This test shows how well the heart's chambers and valves are pumping blood. An echocardiogram also can see if the heart's muscle is thicker than it should be.
  • Electrocardiogram (ECG or EKG). This quick and painless test measures the electrical activity of the heart. Sticky patches called electrodes are placed on the chest and sometimes the arms and legs. Wires connect the electrodes to a computer, which prints or displays 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 provides information 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 the heart is monitored. Exercise stress tests help reveal how the heart responds to physical activity.
  • Cardiac CT scan. Rarely, this test is done to diagnose hypertrophic 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.


The goals of hypertrophic cardiomyopathy treatment are to ease symptoms and prevent sudden cardiac death in people at high risk. Treatment depends on how severe the symptoms are.

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


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

Several surgeries or procedures are available to treat cardiomyopathy or its symptoms. They include:

  • Septal myectomy. This open-heart surgery might be recommended if medicines don't improve symptoms. It involves removing 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 reduces backward flow of blood through the mitral valve.

    The surgery can be done using different approaches, 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 procedure use alcohol to shrink the thickened heart muscle. A long, thin tube called a catheter is placed 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, is one complication. A heart block must be treated with a pacemaker. The small device is placed in the chest to help control the heartbeat.
  • Implantable cardioverter-defibrillator (ICD). This device is placed under the skin near the collarbone. It continuously checks the heart rhythm. If the device finds an irregular heartbeat, it sends out low- or high-energy shocks to reset the heart's rhythm. Use of an ICD has been shown to help prevent sudden cardiac death, which occurs 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.

Hypertrophic cardiomyopathy and treatment options

Steve R. Ommen, M.D., Cardiovascular Diseases, Mayo Clinic: The hypertrophic cardiomyopathy is a condition that has been under-diagnosed and overly feared throughout the world. In the United States alone, there are over a half a million people that have hypertrophic cardiomyopathy, many of whom are completely asymptomatic and unaware of their diagnosis. Some people can die suddenly. Sudden cardiac death occurs randomly without warning.

Hartzell V. Schaff, M.D., Cardiac Surgery, Mayo Clinic: Over 2/3 of the patients will have obstruction. And the obstruction to the left ventricular outflow tract is an indication for operation in patients that have symptoms. So we know now that 2/3 of the patients with hypertrophic cardiomyopathy and obstruction are candidates for surgery.

Dr. Ommen: Hypertrophic cardiomyopathy is the most common inherited cardiomyopathy or heart muscle disease. People are born with the genetics for it, but the hypertrophy doesn't appear to start developing until adolescence, growth spurts, or beyond. It is possible for infants to born with thick heart muscles, but that's really quite rare and usually more severe expressions of the disease. And it's also been described as not coming on until people were in their fifth or sixth decade of life. So really, the onset can be at any time of life. And certainly the symptoms can occur throughout life.

Dr. Schaff: The common symptoms that patients have when they have obstructive hypertrophic cardiomyopathy are shortness of breath, angina-like chest pain and syncope. And unfortunately, some of these symptoms develop so slowly and over such a long time that the patients don't really understand how limited they are.

Dr. Ommen: For patients who have symptoms due to hypertrophic cardiomyopathy, the first line of therapy is always to use medical management, medications. Usually, that's adding specific medications, but sometimes patients are on medications that can make their situation worse. And so some of the most effective therapy is removing the wrong agents, and then perhaps having to add in the right agents to help them with their symptoms down stream.

For patients who don't respond to those medical changes, or for whom those medications caused side effects that are intolerable, then that's when we move to things like surgical myectomy, which can more definitively relieve their symptoms.

Dr. Schaff: The patients who are referred for surgery almost always have either failed medical treatment or have side effects from the medicines that limit them just as much as the symptoms from hypertrophic cardiomyopathy. So operation to relieve outflow tract obstruction is to relieve the symptoms. And in some patients, to allow them to get off of the medications that are having unwanted side effects.

Dr. Ommen: Surgical myectomy has been a very successful operation for many of our patients. However, it is not utilized as much as it maybe could be in part owing to prior perceptions about increased risk with the operation, lack of universal availability of surgeons who can do it. But in the hands of expert centers, the complication rates are very low and our success rates are very high.

Dr. Schaff: We now do a more extensive septal myectomy that extends towards the apex of the heart. And we've learned over the years that it's this distal portion of myectomy that's the most important in terms of relieving symptoms. The few patients who have had a second operation, who have been referred to us after having an operation that was unsuccessful, we found that the myectomy was not carried far enough into the ventricle. It's really not a regrowth of muscle. It's just an inadequate initial operation.

Dr. Ommen: With surgical myectomy, the surgeon removes a portion of the hypertrophied septum, which is narrowing the path of blood, out of the heart. By doing this, it changes the direction the blood flows through the ventricle. It allows the mitral valve to function normally. And allows blood to leave the heart without increasing pressures or increasing forces. This muscle doesn't regrow over time. It is a permanent fix.

Dr. Schaff: We found that it's rarely necessary to do something to the mitral valve. And the hazard with doing something to the mitral valve, where it turns out to be unnecessary, is there is a chance of injury. So we would prefer to do a septal myectomy, come off bypass, assess the mitral valve with an echocardiogram during surgery, before then addressing the mitral valve if there is residual regurgitation.

We can tell if the mitral regurgitation is relieved immediately after the myectomy once the aorta is closed and the heart is restarted. The echocardiogram is done in the operating room and we know right away whether the mitral regurgitation has been relieved. An operation is available for some patients that have non-obstructive hypertrophic cardiomyopathy. And these are patients with the apical distribution of hypertrophy.

Some of those patients have diastolic heart failure related to very small ventricular cavities. And in these patients, doing a transapical myectomy to enlarge the ventricle can improve their symptoms of heart failure.

Dr. Ommen: While we see great results from the surgical myectomy as performed now, it is still something that should only be performed at true centers of excellence. Recent data that have come out have suggested that at low, medium, and even quote unquote "high volume" centers, there is a gradient of mortality, meaning it's highest at the low volume centers and lowest at the high volume centers.

But even those so-called high volume centers have mortality rates that are dramatically higher than what is reported from the true expert centers. And this is a procedure that should be done by those who are very familiar with this procedure, and doing a lot of them.

Dr. Schaff: At Mayo Clinic, we've done over 3,000 operations for hypertrophic cardiomyopathy. We do 200 to 250 operations each year. The mortality for the procedure is less than 1%, especially for patients who are otherwise healthy.

Dr. Ommen: One of the biggest parts of every interaction that I have with patients is helping them understand what their individual risk for sudden cardiac death might be, and whether they might consider having an implantable defibrillator. Our patients who have had surgery have a lower rate of sudden cardiac death and a lower rate for their defibrillators to discharge among those who have had them.

Dr. Schaff: One of the things we've learned after doing septal myectomy is that actually the incidence of ventricular arrhythmia seems to be reduced. And this is shown in studies that look at defibrillator discharges and rates of sudden death.

Dr. Ommen: The inheritance pattern of hypertrophic cardiomyopathy is autosomal dominant, which means each of the children of a patient with HCM has a 50/50 chance of inheriting this disease. We do recommend screening for all first-degree relatives, which is either genetic testing or echocardiographic-based surveillance. When a family has chosen to use echocardiography as their screening tool, we recommend that adult first-degree relatives get screened every five years. First-degree relatives who are adolescents or athletes, we usually screen every 12 to 18 months.

Dr. Schaff: Septal myectomy cures the symptoms of hypertrophic cardiomyopathy when it relieves the obstruction. But of course, patients still have hypertrophic cardiomyopathy, still need to be followed by their physician for the other problems related to hypertrophic cardiomyopathy. But hopefully, are relieved of the shortness of breath, chest pain, or light-headedness that leads to the operation.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

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

  • Exercise. Ask your healthcare professional about the amount and type of exercise that's safe for you.
  • Eat a healthy diet. Eat a healthy diet that's low in salt and solid fats and rich in fruits, vegetables and whole grains.
  • Don't smoke. If you smoke and can't quit on your own, talk to a healthcare professional about strategies or programs to help.
  • Stay at a healthy weight. This helps prevent excessive stress on the heart. It also lowers health risks linked with surgery or other procedures. Talk with your care team to set realistic goals for body mass index (BMI) and weight.
  • Limit or stay away from alcohol. Sometimes, irregular heart rhythms 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. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and up to two drinks a day for men.
  • Control blood pressure and cholesterol. High blood pressure and high cholesterol increase the risk of heart disease. Make lifestyle changes and take medicines as directed to manage high blood pressure or high cholesterol. 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 or worsening symptoms.
  • Practice good sleep habits. Poor sleep may increase the risk of heart disease and other chronic conditions. Adults should aim 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 strategies that might help.

Coping and support

Connect with friends and family or a support group. You may find that talking about hypertrophic cardiomyopathy with others in similar situations can help.

It also is important to control emotional stress. Getting more exercise and practicing mindfulness are ways to ease stress. If you have anxiety or depression, talk to your healthcare team about strategies to help.

Preparing for your appointment

You may be referred to a doctor trained in heart diseases. This type of care professional is 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.
  • Key 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 will I need follow-up appointments?
  • Do I need to restrict my activities?
  • Should my children or other first-degree relatives be screened for this condition, and should I meet with a genetic counselor?
  • How will other conditions that I have or medicines I take affect my heart condition?

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 severe are your symptoms?
  • Have your symptoms changed over time? If so, how?
  • Does exercise or physical exertion 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 had unexplained, sudden death.

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

Hypertrophic cardiomyopathy care at Mayo Clinic

Feb. 23, 2024
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