Diagnosis

Your doctor will examine you and ask questions about your signs, symptoms, and medical and family history.

Tests

Your doctor will likely order tests to diagnose hypertrophic cardiomyopathy (HCM) or rule out other conditions that can cause similar symptoms.

  • Echocardiogram. An echocardiogram is commonly used to diagnose hypertrophic cardiomyopathy. This test uses sound waves (ultrasound) to see if your heart's muscle is abnormally thick. It also shows how well your heart's chambers and valves are pumping blood.

    Sometimes, an echocardiogram is done while you exercise, usually on a treadmill. This is called an exercise stress test. Treadmill stress tests are commonly used to diagnose people with hypertrophic cardiomyopathy.

  • Electrocardiogram (ECG or EKG). Sensors (electrodes) attached to adhesive pads are placed on your chest and sometimes legs. They measure electrical signals from your heart. An ECG can show abnormal heart rhythms and signs of heart thickening. In some cases, a portable ECG, called a Holter monitor, is needed. This device records your heart's activity continuously over one to two days.
  • Cardiac MRI. A cardiac MRI uses powerful magnets and radio waves to create images of your heart. It gives your doctor information about your heart muscle and shows how your heart and heart valves work. This test is often done with an echocardiogram.

Treatment

The goal of hypertrophic cardiomyopathy treatment is to relieve symptoms and prevent sudden cardiac death in people at high risk. Your specific treatment depends on the severity of your symptoms. Together, you and your doctor will discuss the most appropriate treatment for your condition.

Medications

Medications can help reduce how strong the heart muscle squeezes and slow the heart rate so that the heart can pump blood better. Medications to treat hypertrophic cardiomyopathy and its symptoms may include:

  • Beta blockers such as metoprolol (Lopressor, Toprol-XL), propranolol (Inderal, Innopran XL) or atenolol (Tenormin)
  • Calcium channel blockers such as verapamil (Verelan, Calan SR,) or diltiazem (Cardizem, Tiazac)
  • Heart rhythm drugs such as amiodarone (Pacerone) or disopyramide (Norpace)
  • Blood thinners such as warfarin (Coumadin, Jantoven), dabigatran (Pradaxa), rivaroxaban (Xarelto) or apixaban (Eliquis) to prevent blood clots if you have atrial fibrillation

Surgeries or other procedures

Several different surgeries or procedures are available to treat cardiomyopathy or its symptoms. They range from open-heart surgery to implantation of a device to control your heart rhythm.

  • Septal myectomy. This open-heart surgery may be recommended if medications do not improve your symptoms. It involves removing part of the thickened, overgrown wall (septum) between the heart chambers. Septal myectomy helps improve blood flow out of the heart and reduces backward flow of blood through the mitral valve (mitral regurgitation).

    The surgery may 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 destroys the thickened heart muscle with alcohol. The alcohol is injected through a long, thin tube (catheter) into the artery supplying blood to that area. Possible complications include disruption of the heart's electrical system (heart block), which requires implantation of a pacemaker.
  • Implantable cardioverter-defibrillator (ICD). An ICD is a small device that continuously monitors your heartbeat. It's implanted in your chest like a pacemaker. If a life-threatening arrhythmia occurs, the ICD delivers precisely calibrated electrical shocks to restore a normal heart rhythm. ICD has been shown to help prevent sudden cardiac death, which occurs in a small number of people with hypertrophic cardiomyopathy.

Lifestyle and home remedies

Lifestyle changes can reduce your risk of complications related to hypertrophic cardiomyopathy. Your doctor may recommend lifestyle changes, including:

  • Using caution when playing sports. Competitive sports are generally not recommended for people with hypertrophic cardiomyopathy, with the possible exception of some low-intensity sports. You may be able to participate in low- to moderate-intensity exercise as part of a healthy lifestyle. Discuss specific recommendations with your doctor.
  • Eating a healthy diet. A healthy diet is an important part of maintaining your heart health.
  • Maintaining a healthy weight. Maintaining a healthy weight will prevent excessive stress on your heart and reduce health risks associated with surgery or other procedures.
  • Reducing alcohol use. If you have symptoms or a history of rhythms provoked by alcohol, ask your doctor for guidance about safe levels of alcohol use. Drinking too much alcohol can trigger irregular heart rhythms and can lead to increased blockage of blood flow in your heart.
  • Taking your medications. Make sure to take your medications as prescribed.
  • Having regular medical appointments. Your doctor may recommend regular follow-up appointments to evaluate your condition. Let your doctor know if you have any new or worse symptoms.

Pregnancy

Women who have hypertrophic cardiomyopathy can generally have normal pregnancies. However, if you have hypertrophic cardiomyopathy, your doctor may recommend that you see a doctor experienced in caring for women with high-risk conditions during your pregnancy.

Coping and support

Being diagnosed with hypertrophic cardiomyopathy can cause a range of difficult emotions. Like many people with this condition, you may experience feelings of grief, fear and anger. These responses are appropriate to the lifestyle changes that come with your diagnosis.

To cope with your condition:

  • Reduce your stress. Find ways to reduce your stress.
  • Get support. Get support from your friends and family.
  • Follow lifestyle changes your doctor recommends. Making healthy lifestyle changes, such as eating a healthy diet and maintaining a healthy weight, can help you cope with living with your condition.

Preparing for your appointment

You may be referred to a doctor trained in diagnosing and treating heart conditions (cardiologist). Here's some information to help you prepare for your appointment.

What you can do

  • Find out if you need to follow any pre-appointment restrictions, such as changing your activity level or your diet.
  • Write down your symptoms and how long you've had them.
  • Take a list of all your medications, vitamins or supplements.
  • Write down your key medical information, including other diagnosed conditions.
  • Write down key personal information, including any recent changes or stressors in your life.
  • Write down questions to ask your doctor.

Questions to ask your doctor

  • What's the most likely cause of my symptoms?
  • What kinds of 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 medications I take affect my heart problem?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may make time to go over points you want to spend more time on. You may be asked:

  • When did you begin experiencing symptoms, and how severe are they?
  • Have your symptoms changed over time? If so, how?
  • Does exercise or physical exertion make your symptoms worse?
  • Have you ever fainted?
  • Do you have a family history of heart disease?

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 experienced unexplained, sudden death. It will help your doctor to know as many details as possible about your family medical history.

If exercise makes your symptoms worse, avoid strenuous exercise until you have seen your doctor and received specific exercise recommendations.