Hypertrophic Cardiomyopathy: Symptoms, Cause, Treatment

Hypertrophic cardiomyopathy (HCM) is a prevalent heart disease. A study by Kalra (2017) showed that nearly 2 million people in India have this condition. It occurs due to inherited genes, namely myosin-binding protein C (MYBPC3) and Beta-myosin heavy chain (MYH7).

Hypertrophic obstructive cardiomyopathy is the most common type of this disease. HCM is usually diagnosed during the late thirties, although the symptoms may occur in puberty. Since some individuals are asymptomatic, this condition often goes unnoticed. If left untreated, it may lead to other heart complications, such as heart failure, stroke, or sudden cardiac arrest. 

Learn more about hypertrophic cardiomyopathy, its symptoms, causes, diagnosis, treatment, and prevention.

Hypertrophic cardiomyopathy causes thickening of the cardiac muscle. This affects the cardiac functioning to pump blood efficiently. The delayed progression of the disease implies that some individuals remain asymptomatic, which contributes to the failure in earlier detection of the issue. 

There are two types of hypertrophic cardiomyopathy. These are:

1. Obstructive: Also called Hypertrophic Obstructive Cardiomyopathy (HOCM), in this condition, the wall between the two lower chambers of the heart (the right and left ventricles) thickens. This blocks or obstructs the blood flow from the left chamber to the main artery (aorta). It can cause sudden cardiac death (SCD) in young people as well as trained athletes.
2. Nonobstructive: In this type of Hypertrophic Cardiomyopathy, the wall between the heart chambers is thickened without complete blood flow obstruction. Instead, it leads to reduced supply with every heartbeat. In comparison to HOCM, this condition is associated with reduced fatality risks, fewer cardiac complexities, and lower chances of suffering complete heart failure.

Hypertrophic cardiomyopathy symptoms usually appear during adolescence or early adulthood. The severity differs among people. Some may experience signs of the condition, while others may not. 

Common symptoms of hypertrophic cardiomyopathy are:

1. Chest Pain: It is a common symptom and occurs primarily during physical activity like running and sports. Medications generally do not provide effective relief from the pain.
2. Shortness of Breath: Breathlessness is typically observed among adults. It happens due to increased pressure on the left chamber and the lungs caused by physical exertion. 
3. Abnormal Heartbeat: The thickening of the heart muscles changes the overall cardiac structure, leading to an irregular heart rate.
4. Dizziness: Due to irregular heartbeat, patients experience frequent unconsciousness.
5. Palpitations: People with HCM often feel their heart rate is increasing significantly. This also occurs due to abnormal heartbeat. 
6. Swelling: In hypertrophic cardiomyopathy, the heart has difficulty pumping enough blood. This causes fluid accumulation in the legs and feet, which leads to swelling.

Hypertrophic cardiomyopathy is an inherited condition. It is caused due to the mutation of genes, including MYH7, MYBPC3, TNNT2 and TNN13. These genes are responsible for forming the cellular structure of the cardiac muscles responsible for contraction (sarcomere). 

The mutations in the aforementioned sarcomere-associated genes either result in structural deformities or reduce the production of the cells. Thus, the genetic abnormality changes cause inefficient contraction and relaxation. However, doctors are still exploring the disease development pathway and the relationship between these mutations and heart functioning.  

Hypertrophic Cardiomyopathy Risk Factors

As hypertrophic cardiomyopathy is an autosomal dominant disease or an inherited disease, it is passed down even with a single-parent carrier. In such a case, children have a 50% chance of having the genetic mutation of this condition. The disease is related to the X chromosome, which implies that it can be acquired or transmitted by both males and females. 

People with parents or siblings having this condition should, therefore, ask their doctors for screenings of the disease. This will help in the timely detection of the condition and medical help.

Apart from the familial causes and risks of the disease, certain factors impact disease progression. Such facilitators can contribute to developing health complications along with the underlying cardiac issues related to HCM.

1. Age: It has been studied by Lu et al., 2022 that with consistently growing individuals, the complication risk of ischemic heart increases in HCM patients. Cardiac functioning begins deteriorating among older individuals along with hypertrophic cardiomyopathy and enhances the risk of fatalities.
2. Hypertension: Irregularities in the blood supply due to high blood pressure cause damage to the cardiovascular system. When an individual sustains such damage, it can further facilitate the deformity of the heart with HCM. Thus increasing the chances of cardiac complications.
3. Diabetes: Irregular calcium level, oxidative stress, and increased inflammation cause cardiac dysfunction. This results in complications related to HCM and gradual failure.
4. Smoking: Toxins and tobacco content are found to be related to the narrowing of the arteries. Such harmful substances lead to their accumulation within the inner lining of the cardiac vessels (plaque formation). The deposition further restricts the blood supply, worsening the HCM symptoms.
5. Alcohol Intake: Consumption of liquor is considered a significant contributor to deteriorating symptoms like irregular heart rhythms, hypertension, breathlessness, and palpitations. These worsening aspects then increase the burden on a deformed HCM heart. It leads to an ischemic stroke or life-threatening cardiac complications.

Hypertrophic cardiomyopathy is caused by an abnormal gene. Timely identification and early treatment can help lower the risk of complications.

Here are some precautions that can help get timely treatment and improve the person's quality of life.

Doctors suggest repeated echocardiograms if genetic screening does not prove helpful. 

1. If a parent or a sibling has hypertrophic cardiomyopathy, doctors advise genetic testing to screen for the condition. Echocardiograms may be repeated if genetic screening does not prove helpful. 
2. People engaging in active sports and adolescents at high risk of the disease must get an annual screening. 
3. Regular health check-ups with a cardiologist can help monitor the condition. 
4. Lifestyle changes, like adopting a healthy diet, quitting smoking and alcohol, and following low-intensity exercise, will help improve the quality of life. 
5. Taking all the prescribed medications per the doctor's directions will help lower the risk of complications like high blood pressure and heart attack.

Here are some do's and don'ts for people with hypertrophic cardiomyopathy to help reduce the risk of complications:

Do's:

1. Include heart-healthy foods like leafy green vegetables, whole grains, fruits and nuts in your diet. A balanced diet promotes metabolic stability and better heart functioning. 
2. Walking and cycling in moderation can help improve your overall health. Engaging in adequate physical activities balances the blood supply throughout the body. Thus minimising the risk of decreased blood flow. Although, please consult your doctor about the ideal exercise routine for your condition. 
3. Stay hydrated, but avoid drinking excess amounts of water. Appropriate fluid intake is associated with enhanced hemolytic balance (blood supply and utilisation). Please consult your doctor about the amount of water you must consume every day.
4. Maintain appropriate dental health. Infection in the gums can penetrate the heart and cause endocarditis (inflamed inner lining of the heart chamber). 
5. Limit or avoid caffeine or alcohol consumption. Caffeinated beverages and liquor act as stimulators for increased heart rate, hypertension, and cardiac vessel contractions. 
6. Psychological stress can trigger hormonal imbalances in HCM patients. It can further increase the narrowing of arteries and damage to a deformed heart. Thus, engage in stress management techniques, like meditation or relaxation exercises.

Don'ts:

1. Avoid high-intensity exercise or heavy weightlifting. The exertion could lead to arrhythmia (irregular heartbeat).
2. Quit smoking, as it can worsen the HCM symptoms by increasing plaque formation and arterial blockages.
3. Don't indulge in drugs like cocaine or methamphetamines, as they could worsen hypertension.
4. Limit consumption of over-the-counter medications for cough and cold. Please consult your doctor for a prescription. Decongestant medicines contribute to worsening hypertension and heart rate. These also increase the contractions of arteries, subsequently enhancing the complications of hypertrophic cardiomyopathy.

Doctors conduct a thorough physical exam during which they ask about symptoms, family and medical history. Several tests are advised for the identification of hypertrophic cardiomyopathy. These tests are:

1. Echocardiogram: This is a commonly conducted diagnostic test. Sound waves from ultrasound check if the heart muscles have thickened. It also helps study how well the heart pumps blood. 
2. Electrocardiogram (ECG): It uses electrodes to study the cardiac electrical signalling system. Here, electrodes are placed on the chest to measure the electrical activity. This test helps observe irregular heartbeats and the heart's thickening. 
3. Magnetic Resonance Imaging (MRI): Powerful magnets and radio waves help create images of the heart. Doctors can observe the heart functioning and the thickening of the heart muscles. 
4. Stress test: In this test, the heart is monitored under exertion, like when walking or exercising on a stationary bike. Medical experts evaluate cardiac activity to understand the origin of abnormality.
5. Cardiac Catheterisation: A catheter or a tiny tube is inserted into a blood vessel in the arm and then passed into the cardiac chamber. Contrast dye is released into the bloodstream, which helps capture X-ray images to observe the heart and blood vessels.

How Should You Prepare for the Doctor's Consultation?

1. Before visiting a cardiologist, you can prepare yourself in the following ways :
2. Make a list of the concerns you would like addressed
3. Bring a relative with you to the appointment
4. Mention your current medical conditions, medications and supplements 
5. Explain your family history to the doctor
6. The doctor will collect your personal and medical history of heart disease
7. You can expect your thorough physical examination with blood tests and other diagnoses
8. The following are questions you may like to ask the doctor:

1. Can the condition be prevented with diet and lifestyle changes?
2. What tests are needed?
3. What is the treatment for hypertrophic cardiomyopathy?
4. If your doctor mentions surgery, ask them if surgery is necessary or if the condition can be managed without surgery.

Doctors create a treatment plan to help relieve the symptoms and prevent sudden cardiac death (SCD). The prescribed medicines help reduce the heart rate and enable the heart to pump blood more efficiently. 

Non-surgical Treatment

Hypertrophic cardiomyopathy treatments are available in Ayurveda, Homoeopathy, and Allopathy. These are as follows:

Ayurveda

The following therapies of Ayurveda involving herbs and rejuvenating processes are effective for hypertrophic cardiomyopathy treatment :

1. Abhyangaand Snehana include massaging and external oleation or using medicated oils externally. Regularly applying herbal oils helps restore arterial strength and improve cardiac function.
2. Swedana (passive heat therapy) is also beneficial among cardiac patients in research by Sonare and Wackchaure in 2023. The patients were subjected to herbal and medicinal steam that relieves contraction issues of the left ventricle.
3. Hridya Basti involves providing continuous heat in the form of warm medicinal oil on Urah Sthana (location of the heart). This leads to a better blood flow from the arteries by broadening the arteries.
4. Hrudaya Dhara also helps in regaining cardiac functioning by using an herbal mixture. During this technique, the mixture is dripped over the heart (externally) from the appropriate height.

Along with these therapies, certain herbs are used to treat hypertrophic cardiomyopathy. These help calm the effect of the doshas and remove the toxins from the body. These herbs are:

1. Ashwagandha: It contributes to cardiac muscle building and subsequently strengthens it.
2. Dashamoola: A combination of ten dried herbs and is highly beneficial in reducing inflammation. Thus, it reduces the intensity of various symptoms like breathlessness and fatigue. It is also considered for eliminating toxins and increasing cardiac muscular strength. 
3. Arjuna: This herb is used in Ayurveda to increase the blood supply in HCM patients. It acts like a preventive medication and lowers cardiac damage. The herbal substance also helps alleviate symptoms like decreased oxidative stress and breathing issues.
4. Elaichi: A simple kitchen ingredient has shown to be significantly beneficial as a blood thinning agent. In Hypertrophic Obstructive Cardiomyopathy patients, it enhances blood supply from and to the heart. Although, it is not recommended for individuals who consume anticoagulant medicines and pregnant women.

Homoeopathy

Some homoeopathic therapies for hypertrophic cardiomyopathy include :

1. Aurum Metallicum: These support the treatment of irregular heartbeat and heart failure.
2. Digitalis Purpuria: This is also prescribed as a remedy for heart failure and irregular heartbeat.
3. Strophanthus: Doctors prescribe this remedy for leg swelling and heart failure. 
4. Crataegus: It is also referred to as a heart tonic. Doctors advise this medicine for heart weakness.

Medications

Regular medications prescribed for hypertrophic cardiomyopathy treatment include:

1. Beta-Blockers and Calcium Channel Blockers: These help treat breathlessness and chest pain. They improve the blood flow to the heart and decrease the blockage of blood flow to the body. 
2. Antiarrhythmic Medications: These drugs help correct the heart rhythm by modifying the electrical current responsible for the heartbeat.. 
3. Anticoagulants: These are blood thinners that consist of medicines to help prevent blood clots.

Surgical Treatment

The surgeries and procedures advised for the treatment of hypertrophic cardiomyopathy are:

1. Septal Myectomy: This is open-heart surgery and is advised if medications do not provide relief from symptoms. In this surgery, doctors remove a part of the thickened wall so that more blood can fill the chamber and flow into the body. It also helps prevent the backward flow of blood into the mitral valve between the left atrium and the left ventricle (chamber). 
2. Septal Ablation: This procedure involves injecting pure alcohol into the artery. This destroys the portion of the thickened muscle in the artery and clears the blockage. 
3. Implantable Cardioverter-Defibrillator (ICD): Doctors implant this device to monitor the heartbeat and heart rhythm. In the case of an arrhythmia, this device delivers a shock and restores the heart rhythm. ICD is recommended for people at a higher risk of cardiac arrest.  

Cost of Hypertrophic Cardiomyopathy Treatment

The cost of hypertrophic cardiomyopathy treatment in India depends on the severity of the condition and the chosen hospital. Many hospitals offer packages that include consultations, diagnostic tests, surgery or procedures, and hospital charges. 

Below are the rough cost estimate ranges for treatment options for hypertrophic cardiomyopathy:

Prognosis and Survival Rate 

The annual mortality rates in people with HCM range from less than 1% to 3-6%. According to studies, these numbers have improved over the years. However, studies suggest that the condition carries a high risk of complications and death. 

Screening of parents is crucial in identifying this condition in children before the onset of symptoms. People with hypertrophic cardiomyopathy are at a high risk of recurrent heart failure. It is a progressive condition that deteriorates over time if left untreated.

Not all people experience hypertrophic cardiomyopathy complications. They live a normal life and do not experience any HCM-related health conditions. However, some people may have health complications if their disease is severe.

Hypertrophic cardiomyopathy complications include:

1. Fainting: Sometimes, an irregular heartbeat or blockage of the blood flow can cause fainting. 
2. Stroke: The blockage in an artery increases the risk of blood clots. These can travel up to the brain and cause a stroke. 
3. Heart Failure: When the heart can't pump blood effectively, it leads to heart failure. This can cause respiratory issues, fatigue, swelling in the legs and feet, dry cough, confusion, dizziness, and bloated stomach.
4. Complications during Pregnancy: Hypertrophic cardiomyopathy can cause arrhythmia, heart failure and ischemic stroke in pregnant women. 
5. Sudden Cardiac Death: It is a rare complication of hypertrophic cardiomyopathy that can occur irrespective of age. A sudden loss of heart function because of a fast heartbeat can cause cardiac arrest, which worsens to sudden cardiac death. 

When to Consult a Doctor?

If you have a family history of hypertrophic cardiomyopathy, consulting a doctor is advisable. Contact a doctor immediately if you are experiencing the below-mentioned signs for more than a few minutes: 

1. Chest pain penetrates to the chest and limbs. Medications do not provide appropriate relaxation to the pain.
2. Breathlessness for a prolonged period, especially during physical activities. However, the symptom is not subsiding even after taking rest.
3. Irregular heartbeat resulting in severe palpitations, dizziness, sweating, and fatigue.

Diet for Hypertrophic Cardiomyopathy

Diet supports the treatment and management of hypertrophic cardiomyopathy significantly. Your nutritionist can assist in creating a heart-healthy diet plan that is easy to follow. 

Consume foods rich in fibre, proteins, vitamins, and minerals for weight management. It helps in lowering cholesterol, blood pressure and blood glucose levels:

1. Fruits rich in vitamins A and C, such as berries, papaya, grapes, and oranges
2. Leafy green vegetables, tomatoes, cabbage, carrots, lady fingers, and sweet potatoes
3. Whole grains like wheat, oats, brown rice, quinoa, and barley
4. Beans
5. Nuts, such as almonds and walnuts
6. Flax and chia seeds
7. Tofu
8. Olive oil
9. Heart-healthy non-vegetarian foods ideal for people with hypertrophic cardiomyopathy include:
10. Lean meat, like skinless chicken, lamb (leg, loin and shank) and pork (tenderloin and loin chops). 
11. Fish, such as tuna and salmon 
12. Low-fat milk and yoghurt

Here are some diet rules advised by doctors for people with HCM:

1. Avoid foods low in saturated and trans fats, such as fried foods, red meat, sausages, full-fat milk and baked foods. 
2. Avoid foods high in sugar, namely, chocolates, candies, cakes, cookies, sodas, sweetened juices and sports drinks. These are high in calories and bad for your heart. 
3. Avoid high-salt foods, such as salted nuts, cheese, ketchup, pickles, sausages, ham, ready-to-eat soups, pizzas, breads and salad dressings. 
4. Prepare food with minimum salt.
5. Choose beverages low in added sugar, such as coconut water, vegetable juices, herbal teas and unsweetened coffee. 
6. Limit alcohol consumption, as it can cause obstruction in the heart and further affect blood flow. 
7. Consult your doctor about the quantity of water to consume. Excess water can cause fluid build-up, whereas less water can cause dehydration.

Hypertrophic cardiomyopathy can be managed with medical help with dietary and lifestyle changes. If you have a family history of the condition, please consult a cardiologist. They will advise diagnostic tests and prescribe an ideal treatment. 

If you or your loved ones have any doubts regarding hypertrophic cardiomyopathy, please contact a HexaHealth expert. We provide a one-stop platform for all your healthcare needs, from consultation with high-rated doctors to entire treatment insurance formalities. Don't hesitate to contact us now for a personalised healthcare experience.

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