Table of ContentsView AllTable of ContentsMedicationsLifestyleTherapiesICDsNext in Hypertrophic Cardiomyopathy GuideSymptoms of Hypertrophic Cardiomyopathy
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Table of Contents
Medications
Lifestyle
Therapies
ICDs
Next in Hypertrophic Cardiomyopathy Guide
The primary treatment options forhypertrophic cardiomyopathy(HCM) are medications like beta-blockers and calcium channel blockers. Lifestyle changes can also help control HCM symptoms. If symptoms continue despite medical therapy, more invasive therapies like procedures or device installation may be recommended.
This article discusses HCM treatment, from medications to more invasive or surgical options.
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People with HCM can have symptoms, such as chest pain, fainting, and lightheadedness, due to obstruction of blood flow out of the heart due to the thickened heart muscle.Medications are used to help with symptoms in HCM.
Beta-Blockers
Beta-blockersare the first-line treatment for symptoms of HCM.
Beta blockers used to treat HCM include:
Beta-Blockers to AvoidSome beta-blockers should be avoided in HCM because they can also causevasodilation, or dilation of the blood vessels, which can worsen symptoms. Specific beta blockers that should generally be avoided in HCM includecarevedilolandlabetalol.
Beta-Blockers to Avoid
Some beta-blockers should be avoided in HCM because they can also causevasodilation, or dilation of the blood vessels, which can worsen symptoms. Specific beta blockers that should generally be avoided in HCM includecarevedilolandlabetalol.
Calcium Channel Blockers
The calcium channel blockersverapamilanddiltiazemmay be used in place of beta-blockers in people who do not tolerate beta-blockers.People who experience unwanted side effects, likefatigue, from beta-blockers may better tolerate a calcium channel blocker.
Calcium channel blockers can be a good choice for people withasthma, since beta-blockers mayworsen asthma symptoms.
Disopyramide
When beta-blockers and calcium channel blockers fail to control symptoms in HCM,disopyramidemay be used.
This medication is a type of antiarrhythmic drug that also decreases the heart’s contraction. Because it can also stimulate arrhythmias, it’s not the first choice medication, but it can be helpful when other medications fail.
Mavacamten
A Phase 3 clinical trial of mavacamten showed that in people with obstructive HCM, symptoms and exercise capacity were improved compared to placebo. However, compared to the more invasive treatments for HCM, it is not as effective at reducing severe obstruction in HCM.
Lifestyle Considerations
Talk to yourcardiologistor healthcare provider before participating in strenuous exercise or competitive sports due to the risk of arrhythmia and sudden cardiac death (SCD). Most people are encouraged to exercise at moderate intensity.
Septal Reduction Therapy
Septal reductiontherapy is a type of invasive therapy that aims to decrease the bulk of the thickened muscle to improve the obstruction of blood flow out of the heart.
Due to its invasive nature and risks, this type of therapy is generally reserved for people with severe symptoms despite medical therapy.
Septal reduction therapy may be done with alcoholseptal ablationorseptal myectomy.
Alcohol Septal Ablation
In this procedure, a catheter is used to enter the coronary blood vessel that feeds the thickened muscle in the heart, delivering alcohol that causes scarring. This results in thinning of the muscle with the purpose of relieving obstruction.
Alcohol septal ablation success is somewhat lower compared with septal myectomy. About 7% of the time, the obstruction is not entirely relieved, and further procedures or surgery may be required.
Septal Myectomy
Septal myectomy is a type of heart surgery performed in specialized centers.
During this surgery, an experienced cardiothoracic surgeon gains access to the heart and removes part of the thickened heart muscle to relieve obstruction. Abnormalities of other parts of the heart, such as the mitral valve, can be fixed at the same time if necessary.
While septal myectomy is effective at relieving the obstruction, the risks of performing surgery on the heart need to be considered.The choice between alcohol septal ablation and septal myectomy is based on a person’s characteristics and discussion with their healthcare team.
Implantable Cardioverter Defibrillator (ICD)
One devastating complication of HCM is sudden cardiac death (SCD) due to dangerous arrhythmias, such asventricular tachycardiaandventricular fibrillation.
Because of this, cardiologists may recommend the placement of animplantable cardioverter defibrillator(ICD), a device that monitors the heart rhythm and can deliver an electric shock to stop dangerous arrhythmias.
Certain risk factors increase the risk of SCD and can be an indication of an ICD:
Summary
When medical therapy fails and symptoms are still present and severe, invasive therapy with either alcohol septal ablation or surgery may be recommended.
A Word From Verywell
Hypertrophic cardiomyopathy can be a stressful diagnosis, but your healthcare team can help find a treatment plan that controls symptoms, improves quality of life, and decreases risk of sudden cardiac death. The treatments for HCM have been used for decades, but newer medical therapies may be promising in the future.
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Heart Association.Hypertrophic cardiomyopathy.Ommen SR, Mital S, Burke MA, et al.2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.Circulation. 2020;142:e558–e631. doi:10.1161/CIR.0000000000000937Adler A, Fourey D, Weissler-Snir A, et al.Safety of outpatient initiation of disopyramide for obstructive hypertrophic cardiomyopathy patients.J Am Heart Assoc. 2017;6(6):e005152. doi:10.1161/JAHA.116.005152Maron MS, Ommen SR.Exploring new and old therapies for obstructive hypertrophic cardiomyopathy: mavacamten in perspective.Circulation. 2021;143(12):1181-1183. doi:10.1161/CIRCULATIONAHA.120.051330American College of Cardiology.Hypertrophic cardiomyopathy in 2021: new insights, new strategies, and (possibly) a new treatment.Kimmelstiel C, Zisa DC, Kuttab JS, et al.Guideline-based referral for septal reduction therapy in obstructive hypertrophic cardiomyopathy is associated with excellent clinical outcomes.Circ Cardiovasc Interv. 2019;12(7):e007673. doi:10.1161/CIRCINTERVENTIONS.118.007673American College of Cardiology.Treatment of hypertrophic cardiomyopathy: what every cardiologist needs to know.
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Heart Association.Hypertrophic cardiomyopathy.Ommen SR, Mital S, Burke MA, et al.2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.Circulation. 2020;142:e558–e631. doi:10.1161/CIR.0000000000000937Adler A, Fourey D, Weissler-Snir A, et al.Safety of outpatient initiation of disopyramide for obstructive hypertrophic cardiomyopathy patients.J Am Heart Assoc. 2017;6(6):e005152. doi:10.1161/JAHA.116.005152Maron MS, Ommen SR.Exploring new and old therapies for obstructive hypertrophic cardiomyopathy: mavacamten in perspective.Circulation. 2021;143(12):1181-1183. doi:10.1161/CIRCULATIONAHA.120.051330American College of Cardiology.Hypertrophic cardiomyopathy in 2021: new insights, new strategies, and (possibly) a new treatment.Kimmelstiel C, Zisa DC, Kuttab JS, et al.Guideline-based referral for septal reduction therapy in obstructive hypertrophic cardiomyopathy is associated with excellent clinical outcomes.Circ Cardiovasc Interv. 2019;12(7):e007673. doi:10.1161/CIRCINTERVENTIONS.118.007673American College of Cardiology.Treatment of hypertrophic cardiomyopathy: what every cardiologist needs to know.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Heart Association.Hypertrophic cardiomyopathy.Ommen SR, Mital S, Burke MA, et al.2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.Circulation. 2020;142:e558–e631. doi:10.1161/CIR.0000000000000937Adler A, Fourey D, Weissler-Snir A, et al.Safety of outpatient initiation of disopyramide for obstructive hypertrophic cardiomyopathy patients.J Am Heart Assoc. 2017;6(6):e005152. doi:10.1161/JAHA.116.005152Maron MS, Ommen SR.Exploring new and old therapies for obstructive hypertrophic cardiomyopathy: mavacamten in perspective.Circulation. 2021;143(12):1181-1183. doi:10.1161/CIRCULATIONAHA.120.051330American College of Cardiology.Hypertrophic cardiomyopathy in 2021: new insights, new strategies, and (possibly) a new treatment.Kimmelstiel C, Zisa DC, Kuttab JS, et al.Guideline-based referral for septal reduction therapy in obstructive hypertrophic cardiomyopathy is associated with excellent clinical outcomes.Circ Cardiovasc Interv. 2019;12(7):e007673. doi:10.1161/CIRCINTERVENTIONS.118.007673American College of Cardiology.Treatment of hypertrophic cardiomyopathy: what every cardiologist needs to know.
American Heart Association.Hypertrophic cardiomyopathy.
Ommen SR, Mital S, Burke MA, et al.2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.Circulation. 2020;142:e558–e631. doi:10.1161/CIR.0000000000000937
Adler A, Fourey D, Weissler-Snir A, et al.Safety of outpatient initiation of disopyramide for obstructive hypertrophic cardiomyopathy patients.J Am Heart Assoc. 2017;6(6):e005152. doi:10.1161/JAHA.116.005152
Maron MS, Ommen SR.Exploring new and old therapies for obstructive hypertrophic cardiomyopathy: mavacamten in perspective.Circulation. 2021;143(12):1181-1183. doi:10.1161/CIRCULATIONAHA.120.051330
American College of Cardiology.Hypertrophic cardiomyopathy in 2021: new insights, new strategies, and (possibly) a new treatment.
Kimmelstiel C, Zisa DC, Kuttab JS, et al.Guideline-based referral for septal reduction therapy in obstructive hypertrophic cardiomyopathy is associated with excellent clinical outcomes.Circ Cardiovasc Interv. 2019;12(7):e007673. doi:10.1161/CIRCINTERVENTIONS.118.007673
American College of Cardiology.Treatment of hypertrophic cardiomyopathy: what every cardiologist needs to know.
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