Hypertrophic Cardiomyopathy (cont.)
IN THIS ARTICLE
Many people with hypertrophic cardiomyopathy do not need treatment. But in some cases, having a thickened heart muscle can cause problems. If symptoms develop, treatment is usually recommended. Medicines cannot cure hypertrophic cardiomyopathy, but they may be used to treat complications, including atrial fibrillation and heart failure. These medicines include:
Atrial fibrillation occurs in about 1 out of 4 people who have hypertrophic cardiomyopathy. In atrial fibrillation, abnormal electrical impulses cause the upper chambers of the heart (atria) to fibrillate, or quiver, resulting in irregular and rapid beating of the ventricles, the heart's main pump. For most people, this aspect of atrial fibrillation in itself is usually not life-threatening. But for people who have hypertrophic cardiomyopathy, atrial fibrillation can increase your risk for other abnormal heart rhythms that can be life-threatening. It also increases your risk for heart failure and stroke. For these reasons, most doctors aggressively treat atrial fibrillation in people who have hypertrophic cardiomyopathy. Aggressive treatment may include medicines to control the heart rate or rhythm, electrical cardioversion to return the heart to its normal rhythm, or catheter ablation or surgery to destroy heart tissue that is causing atrial fibrillation. For more information, see the topic Atrial Fibrillation.
Anticoagulants often are prescribed for people who have atrial fibrillation. Anticoagulants help protect against blood clots that develop in the heart. Blood clots can be dangerous because they may break loose and travel through the bloodstream (thromboembolism), which may cause a stroke, heart attack, or blocked blood flow to an arm or leg.
Most people with hypertrophic cardiomyopathy should be assessed by a cardiologist to find out their risk for ventricular tachycardia, an abnormally fast heart rate that can result in sudden death. For those in a high-risk category, an implantable cardioverter-defibrillator (ICD) appears to be the most effective treatment for preventing sudden death.
Because of the risk of sudden death, it is important for people with hypertrophic cardiomyopathy to avoid too much strenuous activity and intense exercise. Talk to your doctor about what level of exercise and what kinds of activities are safe. Prolonged activity in hot weather is not recommended, because dehydration can also make symptoms in people with hypertrophic cardiomyopathy worse.
It is important for people with high-risk hypertrophic cardiomyopathy to have frequent check-ups with their doctors. People who are low-risk may not see their doctors as often. But you may see the doctor more often if you have a change in your symptoms or your overall health. When symptoms appear or start to get worse, a check-up might include an echocardiogram (echo), electrocardiogram (ECG, EKG), or exercise test. Your doctor will talk about your symptoms and your health history. You may also talk about the health history of people in your family. These regular visits will help your doctor identify things that may put you at risk for sudden cardiac death and other serious medical conditions.
If symptoms develop, treatment is usually recommended. Medicines cannot cure hypertrophic cardiomyopathy, but they may be used to treat complications, including atrial fibrillation and heart failure. After medicines are started, most people need to take them for the rest of their lives.
Treatment if the condition gets worse
If you have serious heart rhythm problems or are at high risk for sudden death, your doctor might recommend an implantable cardioverter-defibrillator (ICD).
Medicines for heart failure may be used if hypertrophic cardiomyopathy progresses to that advanced state. For more information, see the topic Heart Failure.
A surgery called a myectomy or myomectomy may be advised for some people when medicines do not help relieve severe symptoms of heart failure (NYHA class III and IV) due to hypertrophic cardiomyopathy. In this surgery, a portion of overgrown heart muscle is removed. Often the excess muscle tissue is found in the septum, which divides the left and right lower heart chambers (ventricles). An overgrown septum can interfere with the function of the left ventricle and limit blood flow out of the heart. Most people who have this surgery recover well and end up with fewer symptoms. After surgery, physical activity is easier too.
Another option for people with hypertrophic cardiomyopathy is nonsurgical septal reduction, also called alcohol septal ablation. When the area of the heart muscle that divides the right and left chambers (septum) becomes too thick, the lower left heart chamber (left ventricle) becomes obstructed, which hinders its ability to pump normally. The thickened septum is reduced in size by injecting alcohol into the coronary artery that supplies this area of the heart with blood. The alcohol destroys some of the heart muscle in the thickened septum. This reduces the obstruction and improves the left ventricle's pumping ability. Advantages of this procedure are that major surgery and lengthy recovery are avoided because the alcohol can be given through a catheter during a cardiac catheterization procedure. This procedure can help relieve symptoms. But it is a newer procedure, so the long-term effects are not yet known. Experts recommend that this complex procedure be performed in a large medical center where the staff has substantial experience with it.
eMedicineHealth Medical Reference from Healthwise
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