Hypertrophic cardiomyopathy (HCM) is a condition that affects the heart muscle, causing the walls of the heart — especially the main pumping chamber — to thicken. HCM affects about 1 in 500 people in the United States. The familial form is the most common inherited cardiomyopathy (heart muscle disease).

Some people with HCM never have symptoms, but others may develop serious complications. HCM treatments include medication, surgery, implanted devices, and lifestyle changes. The best approach depends on your health needs.

What Is Hypertrophic Cardiomyopathy?

HCM is usually an inherited disease caused by certain gene mutations (changes). The condition causes abnormal thickening of the ventricular septum — the muscular wall that divides the left and right ventricles (sides of the heart). This thickening makes it harder for the heart to pump oxygen-rich blood out to the body. Symptoms include:

• Shortness of breath
• Dizziness
• Palpitations (racing, fluttering, or pounding heartbeat)
• Chest pain
• Fainting
• Arrhythmia (irregular heartbeat)
• Heart failure (when the heart doesn’t pump as well as it should)

Symptoms often appear only during exercise or strenuous physical activity. In fact, some people with mild HCM may not experience any symptoms. However, people with severe HCM are at risk of more dangerous complications, such as cardiac arrest (when the heart suddenly stops beating).

Treating Hypertrophic Cardiomyopathy

Treatment for HCM depends on your symptoms and how the condition affects your heart.

When determining your treatment options, your doctor will consider which parts of your heart are involved and whether you’re experiencing symptoms or complications.

If you don’t have symptoms, you may not need treatment. However, it’s still important to see a cardiologist regularly. Your doctor may recommend routine echocardiograms (ultrasound pictures of the heart) to check for any changes.

If you don’t have symptoms from HCM, you may not need treatment. However, close follow-up with a cardiologist is recommended.

HCM can be a complex condition to treat. It’s a good idea to get care from doctors and medical centers that have experience with it. For some types of surgery that are specific to HCM, it’s especially important to have surgeons with a great deal of experience.

Below are four common treatment options used to manage HCM.

1. Medication

Current guidelines recommend first-line treatments and advanced treatments based on how HCM affects the heart. Medication is always the first choice, and the type depends on the features of HCM that are present. If medications aren’t enough to manage symptoms or prevent complications, other options, such as surgery, may be considered.

Medications used to treat HCM include:

• Beta-blockers — These slow the heart’s rhythm so that it doesn’t have to work as hard.
• Calcium channel blockers — These drugs help control heart rhythm, relax blood vessels, and reduce how strongly the heart contracts.
• Antiarrhythmic drugs — These medications, which include sodium channel blockers and potassium channel blockers, help prevent or correct irregular heartbeats.
• Anticoagulants — Also called blood thinners, these help prevent blood clots and stroke.
• Low-dose diuretics — Also called water pills, these may help relieve shortness of breath when used with other medications.
• Cardiac myosin inhibitors — This type of treatment helps the heart muscle relax. Mavacamten (Camzyos) was the first of this new class of drugs to be approved by the U.S. Food and Drug Administration (FDA) for HCM. Currently, another cardiac myosin inhibitor is being studied for HCM.

Medication is always the first choice for treating HCM. Surgical procedures and implantable devices are used when medication doesn’t achieve treatment goals.

2. Surgery

If medication isn’t enough to manage your HCM, your doctor may recommend surgery. Common procedures for HCM include:

• Septal myectomy — Reduces the thickness of the interventricular septum to help improve blood flow
• Alcohol septal ablation — Uses alcohol to shrink the thickened heart muscle without invasive surgery
• Transapical myectomy or apical aneurysm repair — Treats problems on the apex (lower tip) of the left ventricle
• Heart valve surgery — Repairs or replaces the mitral valve (the valve that separates the heart’s upper and lower left chambers)

In rare and severe cases that lead to heart failure, a heart transplant may be needed.

3. Implantable Devices

Implantable devices can be used to help manage heart rate and rhythm problems, reduce the risk of sudden cardiac death, or support a weakened heart. These devices, which are placed inside the body and work around the clock, include:

• Implantable cardioverter defibrillator (ICD) — Monitors your heartbeat and can deliver an electric shock to stop a dangerous arrhythmia and prevent sudden cardiac death
• Cardiac resynchronization therapy (CRT) device — Helps correct abnormal heart contractions and keeps the heart from beating too slowly
• Left ventricular assist device (LVAD) — Treats severe heart failure by helping the heart pump blood to the body

4. Lifestyle Changes

Making healthy lifestyle choices can help reduce HCM symptoms and improve your overall well-being. Most people with HCM benefit from regular, mild to moderate exercise. However, your doctor may advise you to avoid competitive sports or intense workouts, depending on how severe your HCM is.

Maintaining a healthy body weight can help your heart function better. Research shows that having a high body weight and not being physically active can make HCM symptoms worse. If you have questions about how body weight affects your heart, your doctor can offer guidance.

You can also try following these lifestyle tips for people living with HCM:

• Keep up with regular medical care — HCM treatment and needs can change over time, so communicating closely with your healthcare providers is key.
• Take care of your teeth and gums — Untreated dental infections can lead to serious heart complications like endocarditis (infection of the heart’s inner lining and valves).
• Reduce stress and support your mental health — Study findings show that anxiety and depression can make HCM symptoms worse. Talking to a mental health professional may help.
• Stop smoking and avoid recreational drugs — Substances like cocaine and methamphetamine are especially dangerous for people living with HCM.

Making these day-to-day changes — along with following your treatment plan and staying connected to your care team — can help you feel better, lower your risk of complications, and live well with HCM.

Talk With Others Who Understand

On MyHeartDiseaseTeam, the social network for people with heart disease and their loved ones, 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.