Hypertrophic Cardiomyopathy (HCM)

Expert diagnosis and treatment for one of the most common genetic heart conditions

Exceptional Care at a World-Class HCM Center

Lahey Clinic is a global destination for people with hypertrophic cardiomyopathy (HCM). Here, you can receive the full spectrum of HCM care with world-renowned HCM specialists. From screening and genetic testing to advanced diagnostics and comprehensive treatments, we offer everything you need to enjoy better heart health and improved quality of life.

What Is Hypertrophic Cardiomyopathy?

HCM often runs in families. It’s one of the most common forms of genetic heart disease.

The condition causes increased thickness of your lower ventricular wall. Usually, this occurs in the muscle that separates the heart’s lower chambers, or ventricles (ventricular septum).

The severity of HCM differs from one person to the next. Some people don’t have symptoms and don’t know they have the condition. But you can develop troubling symptoms. HCM can also be associated with arrhythmias, or abnormal heart rhythms, like atrial fibrillation (AFib) and heart failure. Even when symptoms are severe, with treatment, we can help you feel better and you can live a normal lifespan.

Watch this video to learn more about HCM.

Lahey’s Hypertrophic Cardiomyopathy Center

We are internationally recognized by the Hypertrophic Cardiomyopathy Association as an HCM Center of Excellence. And Expertscape ranks our HCM cardiologists among the best in the world. They not only care for you, they’ve helped establish the largest, most comprehensive HCM conference in existence today. As our patient, you benefit from their expertise and experience, just as other physicians worldwide do.

At the center, you can receive onsite echocardiography imaging tests, including those with exercise. Onsite electrophysiology consults are also available. And you’ll get the treatment that’s right for you. We are one of only a select number of centers in the U.S. to offer both medical and surgical treatments.

More About Hypertrophic Cardiomyopathy

Types of HCM

There are two types of HCM: obstructive HCM and nonobstructive HCM

Obstructive HCM

About 70% of the people with HCM have the obstructive form of the disease. This means your mitral valve, which controls blood from your upper left chamber (atrium) to your left ventricle comes in contact with your thickened septum muscle when your heart contracts. This can partially block blood flow out of your heart. It might be a problem only when your heart rate increases during exercise. But sometimes, blood can also be obstructed when you’re at rest.

When blood has a hard time moving through your heart, pressure in the heart increases. This is what leads to HCM symptoms.

Often, we can manage symptoms with medication. But if medicines aren’t effective, you may need other, more advanced treatments.

Nonobstructive HCM

About 30% of people with HCM have nonobstructive HCM. Your heart muscle has thickened, but blood flows normally. So, you don’t have increased pressure in your heart. Even so, it may be difficult for your left ventricle to fill with enough blood and pump efficiently. Eventually, this may lead to heart failure.

We often treat nonobstructive HCM with medication. If you don’t respond to the treatment, at some point, you might require a heart transplant.

HCM Symptoms & Diagnosis

Symptoms of HCM

Symptoms of HCM are similar to those of other types of heart disease. So we rely on several tests to investigate.

Symptoms may include:

Shortness of breath (the most common symptom).
Fatigue and excessive tiredness.
Sudden and forceful heart beats.

Chest pressure or pain.
Dizziness/lightheadedness.
Loss of consciousness.

The symptoms may be present with or without exertion. Usually, HCM occurs during midlife, but symptoms can develop or worsen at any age.

Diagnosing HCM

To diagnose HCM, we talk with you about your personal and family history. We also do a complete physical exam. Imaging tests and heart tests help us confirm your diagnosis. Your tests may include:

Electrocardiogram (ECG): A quick, painless test asses your heart’s electrical activity.
Echocardiogram (echo): Real-time picture of your heart in motion created with sound waves.
Cardiac MRI: A test that uses sound waves and a strong magnetic field. The test provides clear pictures of the heart muscle wall. This helps us locate and measure the thickened area.
Exercise (stress) echocardiogram: A test we often use if a resting echo shows thickened heart muscle but normal blood flow. It involves walking on a treadmill. We can see if blood is obstructed when your heart rate increases and compare the results to your resting echo.
Ambulatory ECG monitoring: A test that involves wearing a Zio patch to track irregular heart rhythms. This small, wireless device attaches to your skin. You wear it for two to four weeks.
Cardiopulmonary exercise test: A treadmill test. It allows us to see how your body adapts to the energy demands of exercise.

How Common Is HCM?

At one time, doctors considered HCM a rare disease. However, studies now estimate that HCM occurs in one in every 200 to 500 people. This means at least 750,000 Americans may have HCM. The disease affects all races, ethnic groups and both genders.

HCM Treatments

HCM is a complex disease. Treatment that works well for someone else may not be right for you. We personalize your care and find what’s best for you.

We know that a new HCM diagnosis can cause anxiety. But you can rely on us to communicate clearly and help you feel empowered. We want you to be comfortable making treatment decisions with our team.

In some cases, people can live a long life with HCM without major symptoms or complications. If we don’t believe you need treatment, we do recommend monitoring. This can take place at Lahey or with your referring physician.

When treatment is needed, it may control your symptoms and problems that may develop, such as arrhythmias. Treatment may also prevent stroke and reverse heart failure. Several treatments are available.

Medication

Medication may help you control symptoms and any heart rhythm disorders. They may also prevent stroke.

These may include:

Antiarrhythmics (heart rhythm disorder medicines).
Anticoagulants (blood thinners).
Beta blockers.
Calcium channel blockers.
Disopyramide (Norpace).
Myosin inhibitors (a newer class of medications that help the heart beat less forcefully).

Septal Myectomy

Septal myectomy is low-risk surgery with a long history. It removes the obstruction and restores pressure within your heart to normal. It also relieves shortness of breath.

Alcohol Septal Ablation

Alcohol septal ablation is a minimally invasive procedure for people who aren’t good surgical candidates or choose not to have surgery. Doctors deliver alcohol to the area of thickened muscle using a catheter threaded through a blood vessel. The alcohol causes the thickened muscle to shrink.

Implantable Cardioverter Defibrillator (ICD)

An ICD is a device that senses, and automatically corrects, abnormal heart rhythms.

Heart Transplant

Nonobstructive HCM sometimes leads to end-stage heart failure. This is rare. But if it happens, a heart transplant may improve your quality of life and help you live longer. More than 90% of people with HCM who receive a transplant live five years or more.

Preventing HCM Complications

Helping you prevent potential complications of HCM is part of our focus.

Stroke Prevention

Arrhythmias, for example, affect many people with HCM. If you have AFib, your risk of stroke increases. To lower stroke risk, we may recommend:

Blood thinners to reduce clot formation.
Catheter ablation to correct your abnormal heart rhythm.
Medicines to control your heart rhythm.

Life-Threatening Arrhythmia Prevention

Even competitive athletes may have HCM, sometimes without realizing it. For those who are aware of their condition, and others who may be at increased risk of developing a severe arrhythmia, an ICD may be lifesaving.

We consider your risk factors, including your age, when weighing whether an ICD might be beneficial for you. Using these devices to prevent life-threatening arrhythmias is one of the most significant advances in HCM care. Lahey cardiologists are responsible for making ICDs part of HCM care.

Your Expert Care Team

At the center, you have a team of exerts involved in your care. We work together to help you feel and function your best. Team members come from the following specialties: