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How Is Hypertrophic Cardiomyopathy Treated?

Posted on January 03, 2022
Article written by
Kristopher Bunting, M.D.

  • Many treatments are available for hypertrophic cardiomyopathy (HCM), and new treatments are on the way.
  • The best treatment options for your hypertrophic cardiomyopathy depend on the features of your disease and any complications you may have.

Hypertrophic cardiomyopathy is a disease of muscle tissue in the heart that affects as many as 1 in 500 people in the United States, making it the most common inherited cardiomyopathy.

While HCM does not cause symptoms for many people, it can lead to dangerous complications for others. Treatment of HCM can include medication, surgery, implanted devices, and lifestyle modifications. Treatment varies based on the symptoms HCM causes and the changes to the heart that it produces.

What Is Hypertrophic Cardiomyopathy?

Hypertrophic cardiomyopathy is an inherited disease caused by mutations in genes related to the proteins that make up heart muscle. HCM causes the walls of the left ventricle to become thickened, called left ventricular hypertrophy. This thickening can prevent the heart from pumping oxygen-rich blood to the body.

Symptoms of HCM can include shortness of breath, dizziness, palpitations, chest pain, fainting, and a fast or irregular heartbeat. Symptoms often only appear when performing exercise or strenuous physical activity. Some people with mild HCM may not experience any symptoms, while people with severe HCM may experience symptoms even while resting.

HCM can cause obstruction of blood flow through the aorta, which is called obstructive hypertrophic cardiomyopathy or HCM with left ventricular outflow obstruction. HCM can also cause complications, such as arrhythmias and heart failure. Treatment options for HCM vary based on the features and health complications an individual has.

Treatment Options for Hypertrophic Cardiomyopathy

Treatment options for HCM include lifestyle modification, medication, and surgery, as well as the use of noninvasive procedures and implantable devices (such as pacemakers). Treatments are determined based on the features present with HCM, including which specific parts of the heart are involved and whether there are complications, including arrhythmia or heart failure.

If you don’t have symptoms from HCM, treatment may not be needed and may not have any benefit. However close follow-up with a cardiologist is recommended, along with regular echocardiograms to track any potential progression of disease.

Treatment guidelines recommend that people with moderate to severe HCM or HCM with complications seek care from a center that specializes in HCM treatment. HCM can be a complicated disease to treat. It is important to get care from doctors with experience treating it. For some surgeries unique to HCM, it is especially important to have surgeons with a great deal of experience.

Medication

Medication is the first line of treatment for HCM. Medications used to treat HCM include:

  • Beta-blockers — Drugs that slow the heart’s rhythm and allow it to beat with less force
  • Calcium channel blockers — Drugs that can prevent irregular heartbeat, relax blood vessels, and keep the heart from contracting too strongly
  • Antiarrhythmic drugs — Drugs that prevent irregular heartbeat, including sodium channel blockers and potassium channel blockers
  • Anticoagulants — Blood thinners that help prevent blood clots and stroke

Surgery

If medication does not sufficiently control your condition, your doctor may recommend surgery to treat HCM. Surgical procedures for HCM can include:

(Adobe Stock)

Implantable Devices

Implantable devices can be used to help control heart rate, prevent sudden cardiac death, regulate heartbeat, and help synchronize heart contractions. Devices include:

Lifestyle Changes

Certain lifestyle changes can help improve HCM symptoms. Regular mild to moderate exercise is recommended for most people with HCM. Avoiding competitive sports or intense exercise is also recommended, depending on how severe the HCM is.

Maintaining a healthy body weight can help the heart to function better and prevent problems such as sleep apnea and high blood pressure that can make HCM worse.

Are you living with hypertrophic cardiomyopathy?
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What Determines the Best Treatment for Hypertrophic Cardiomyopathy?

Current guidelines for treating HCM recommend first-line treatments and advanced treatments based on specific circumstances. Medication is always the first choice, and the medications used depend on the features of HCM that are present. Surgical procedures and implantable devices are used when medication fails to achieve treatment goals.

Communication with your doctor is important when determining which treatment options are best for you. It is important to have two-way communication with your doctor to find treatments that support your goals and your personal circumstances.

Obstructive HCM

Obstructive HCM, or HCM with left ventricular outflow obstruction, is caused by thickening of the interventricular septum, the wall between the left and right ventricles. If the septum becomes too large, it can interfere with normal blood flow out of the heart through the aorta. Most cases of HCM are obstructive HCM.

Treatment for obstructive HCM begins with beta-blockers and calcium channel blockers. People who do not respond to these medications may need different calcium channel blockers or potassium channel blockers in addition to beta-blockers.

Alcohol septal ablation or a septal myectomy procedure may be needed if medication is insufficient to treat obstructive HCM. Additionally, surgery to repair damage to the mitral valve can help improve outcomes.

Nonobstructive HCM

Nonobstructive HCM is treated with beta-blockers and calcium channel blockers first. Diuretics, or water pills, may be used to treat shortness of breath in nonobstructive HCM. Transapical myectomy to enlarge the interior of the left ventricle may be used in some cases if medication alone does not help.

HCM With Atrial Fibrillation

Atrial fibrillation describes disorganized contractions of the atria, the chambers of the heart that lead to the ventricles. Beta-blockers and calcium channel blockers are the first-line treatment; but amiodarone, an antiarrhythmic drug, may also be prescribed.

Anticoagulants are needed to prevent blood clots and stroke caused by atrial fibrillation. AV (atrioventricular) node ablation may be needed if drugs fail. This procedure requires a pacemaker.

HCM With Ventricular Arrhythmia

Ventricular arrhythmias caused by HCM can be life-threatening and usually require an ICD to prevent sudden cardiac death. Medication is used to help control arrhythmias, including beta-blockers and amiodarone or similar antiarrhythmic drugs.

If medication does not work, then ablation may be needed. Additionally, surgery may be needed to treat apical aneurysm in the left ventricle, essentially a pouch of thinner heart muscle at the tip of the ventricle. Heart transplant may be needed if heart function is severely impaired.

HCM With Heart Failure

Heart failure is one of the more serious and debilitating complications of HCM. Beta-blockers and calcium channel blockers may be used to treat HCM and heart failure, as well as an ICD.

ICDs typically also function as pacemakers, as people with HCM and heart failure may need cardiac resynchronization therapy as well. Severe heart failure may require a left ventricular assist device or heart transplant.

New Treatments Are on the Horizon

Existing treatments for hypertrophic cardiomyopathy are constantly being studied and refined, but new treatments are rare. A new drug called mavacamten is the first drug of its kind, a cardiac myosin inhibitor designed specifically to treat HCM.

Clinical trials have shown that mavacamten is effective in many people for treating symptoms of HCM. Mavacamten has been shown to improve left ventricular obstruction, exercise tolerance, and heart function.

Studies on mavacamten have demonstrated significant improvement in quality of life, including both physical and social function. Currently, the drug is awaiting approval from the U.S. Food and Drug Administration.

Summary

Hypertrophic cardiomyopathy can be a very complicated disease to treat, requiring care from cardiologists and other physicians who specialize in treating HCM. However, there are many effective treatments available for HCM that can improve day-to-day life and allow people with HCM to live a normal life span.

Talk With Others Who Understand

MyHeartDiseaseTeam is the social network for people with heart disease and their loved ones. On MyHeartDiseaseTeam, more than 42,000 members come together to ask questions, give advice, and share their stories with others who understand life with heart disease.

Are you living with hypertrophic cardiomyopathy? What treatments have worked for you? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. Hypertrophic Cardiomyopathy (HCM) — American Heart Association
  2. Hypertrophic Cardiomyopathy — Cleveland Clinic
  3. Cardiomyopathy — American Heart Association
  4. Hypertrophic Cardiomyopathy — Mayo Clinic
  5. Left Ventricular Hypertrophy (Enlarged Heart) — Cleveland Clinic
  6. Hypertrophic Cardiomyopathy — Johns Hopkins Medicine
  7. 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy — Circulation
  8. Arrhythmia — Cleveland Clinic
  9. What Is Heart Failure? — American Heart Association
  10. Echocardiogram — Mayo Clinic
  11. Sleep Apnea — Mayo Clinic
  12. High Blood Pressure (Hypertension) — Mayo Clinic
  13. Beta Blockers — Mayo Clinic
  14. Calcium Channel Blockers — Mayo Clinic
  15. Antiarrhythmic Medications — StatPearls
  16. Blood Thinners — MedlinePlus
  17. Septal Myectomy — Johns Hopkins Medicine
  18. Alcohol Septal Ablation — Johns Hopkins Medicine
  19. Heart Valve Surgery — Mayo Clinic
  20. Cardiac Ablation — Mayo Clinic
  21. Heart Transplant — Mayo Clinic
  22. Sudden Cardiac Death (Sudden Cardiac Arrest) — Cleveland Clinic
  23. Implantable Cardioverter Defibrillator (ICD) — American Heart Association
  24. Pacemaker — Mayo Clinic
  25. Cardiac Resynchronization Therapy (CRT) — American Heart Association
  26. Left Ventricular Assist Devices (Mechanical Circulatory Support MCS) — Cleveland Clinic
  27. Diuretics — Mayo Clinic
  28. Atrial Fibrillation — Mayo Clinic
  29. Amiodarone — MedlinePlus
  30. Atrial Fibrillation Ablation — Mayo Clinic
  31. Ventricular Arrhythmia — Cleveland Clinic
  32. Mavacamten for Treatment of Symptomatic Obstructive Hypertrophic Cardiomyopathy (EXPLORER-HCM): A Randomised, Double-Blind, Placebo-Controlled, Phase 3 Trial — The Lancet
  33. Myosin Modulators: The New Era of Medical Therapy for Systolic Heart Failure and Hypertrophic Cardiomyopathy — Cardiology Research
  34. Mavacamten for Treatment of Symptomatic Obstructive Hypertrophic Cardiomyopathy (EXPLORER-HCM): Health Status Analysis of a Randomised, Double-Blind, Placebo-Controlled, Phase 3 Trial — The Lancet
All updates must be accompanied by text or a picture.
Larry A. Weinrauch, MD, FACC, FACP, FAHA is an assistant professor of medicine at Harvard Medical School with a focus on cardiovascular disease and clinical outcomes research. Review provided by VeriMed Healthcare Network. Learn more about him here.
Kristopher Bunting, M.D. studied chemistry and life sciences at the U.S. Military Academy, West Point, and received his doctor of medicine degree from Tulane University. Learn more about him here.

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