Your health care provider will examine you and ask questions about your signs, symptoms, and medical and family history.
Your provider 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 the heart's muscle is unusually thick. It also shows how well the heart's chambers and valves are pumping blood.
Electrocardiogram (ECG or EKG). Sensors (electrodes) attached to adhesive pads are placed on the chest and sometimes the legs to measure electrical signals from the heart. An ECG can show irregular heart rhythms and signs of heart thickening.
Your health care provider may recommend monitoring your heartbeat at home. A portable ECG device (Holter monitor) can be worn for a day or more to record the heart's activity during daily 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 is often 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.
The goals of hypertrophic cardiomyopathy treatment are to relieve symptoms and prevent sudden cardiac death in people at high risk. Treatment depends on the severity of symptoms. You and your health care provider will discuss the most appropriate treatment for your condition.
If you have cardiomyopathy and are pregnant or thinking about pregnancy, your health care provider might recommend that you see a doctor experienced in caring for women with high-risk pregnancies (perinatologist or maternal-fetal medicine specialist).
Medications can help reduce how strongly 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 might 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 (Jantoven), dabigatran (Pradaxa), rivaroxaban (Xarelto) or apixaban (Eliquis) to prevent blood clots if you have atrial fibrillation or the apical type of hypertrophic cardiomyopathy, which can increase 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 medications don't improve 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 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 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 the heartbeat. It's implanted in the chest like a pacemaker. If a life-threatening arrhythmia occurs, the ICD delivers precisely calibrated electrical shocks to restore the heart 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.
Lifestyle and home remedies
Lifestyle changes, such as the following, can reduce the risk of complications related to hypertrophic cardiomyopathy.
- Exercising. You'll likely be able to engage in moderate-intensity exercise as part of a healthy lifestyle. If you want more-vigorous exercise, talk to your health care provider about your potential risks.
- Eating a healthy diet. A healthy diet is an important part of maintaining heart health.
- Maintaining a healthy weight. Maintaining a healthy weight will prevent excessive stress on the heart and reduce health risks associated with surgery or other procedures.
- Limit or avoid alcohol. In some cases, irregular heart rhythms and blocked blood flow are triggered or worsened by alcohol use. Ask your health care provider 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.
- Having regular medical appointments. Your health care provider might recommend regular follow-up appointments to evaluate your condition. Let your provider know if you develop new or worse symptoms.
Coping and support
Being diagnosed with hypertrophic cardiomyopathy can cause a range of difficult emotions. Feelings of grief, fear and anger aren't uncommon.
To better manage your condition:
- Manage stress. Find ways to help reduce emotional stress. Getting more exercise and practicing mindfulness are ways to reduce stress.
- Seek support. Consider joining a support group. Support groups allow you to connect with others who have similar experiences.
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
When you make the appointment, ask about pre-appointment restrictions, such as changing your activity level or your diet. Make a list of:
- Your symptoms and when they began
- All medications, vitamins and supplements you take, including doses
- Key medical information, including other diagnosed conditions and family history of heart disease
- Questions to ask your health care provider
Questions to ask your health care provider 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 medications I take affect my heart condition?
Don't hesitate to ask other questions you have.
What to expect from your doctor
Your health care provider is likely to ask you a number of 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, avoid strenuous exercise until you have seen your health care provider and received specific exercise recommendations.