Hypertrophic cardiomyopathy (HCM) is a genetic condition that involves abnormal thickening of the heart muscle, which can increase the risk of other heart conditions. But if you have HCM, you can make a number of lifestyle choices to protect your heart health and enjoy a high quality of life.
Don’t: Lift Heavy Objects
Heavy lifting is potentially risky when you’re living with HCM, because it can induce a Valsalva maneuver, according to Aldo L. Schenone, MD, a cardiologist and HCM specialist at the Montefiore Einstein Center for Heart and Vascular Care in New York.
The Valsalva maneuver involves pushing air out with your nose and mouth closed. It’s a noninvasive way to help slow down the heart rate and restore normal heart rhythm. But if you have HCM, the Valsalva maneuver can induce left ventricular outflow tract (LVOT) obstruction, Dr. Schenone says. This blocks your blood’s ability to get out of the left lower chamber of your heart to the rest of your body.
For this reason, Schenone generally encourages people with HCM to avoid exercises and lifting movements that could cause similar straining, especially if it’s prolonged. Weight lifting isn’t always out of the question, but talk with your doctor first. You should get evaluated and receive proper guidance when it comes to these lifting activities and exercises.
Do: Stay Well-Hydrated
Take extra care to prioritize hydration when you’re living with HCM. “Dehydration reduces intravascular [blood] volume, causing the heart to be less filled with blood, [which] may promote LVOT obstruction,” says Schenone.
He also says that because people with HCM have thickened heart muscle, they tend to have smaller heart chambers than people who don’t have HCM. So, the heart tends to hold less blood volume. As a result, it can be harder for the heart to compensate when someone with HCM is dehydrated.
Don’t: Use Hot Tubs or Saunas
Be particularly careful in hot environments.
About two-thirds of people with HCM have obstructive HCM, in which the thickened heart muscle affects blood flow out of the left chamber of the heart. In these cases, low blood pressure can promote LVOT obstruction. That’s because when blood pressure drops, the heart can start to beat more vigorously — muscle movement that increases the likelihood of an obstruction, says Schenone.
Saunas are a hot environment that can cause the blood vessels to dilate (or widen), resulting in reduced blood pressure, says Schenone. What’s more, they can lead to water loss via sweat, which can negatively impact hydration in people with HCM, he says. Similarly, hot tubs can cause blood vessels to widen and lower blood pressure.
Do: Work With an HCM Specialist
It’s a good idea to work with your healthcare team, including an HCM specialist, to make careful, informed decisions about your care.
“I think it’s important that patients with hypertrophic cardiomyopathy are seen at least once by someone who has expertise in the disease,” says Schenone. These specialists have a unique understanding of the condition, and they can help with specific recommendations as to what you can and cannot do safely.
Specialists can also help when it comes to medications, he says. For example, certain medications are better than others for people who have HCM and high blood pressure, as they can treat the conditions while also minimizing the possibility of an LVOT obstruction.
Don’t: Smoke
Not smoking is part of a heart-healthy lifestyle, which makes it important for people with HCM as well. Living with HCM can also put you higher risk for other heart conditions, like heart failure and atrial fibrillation. Smoking may make both of these conditions worse.
“Smoking cessation [and] abstinence is important for anyone for the prevention of cardiovascular disease,” says Schenone. People with HCM are no exception. “Smoking is among the strongest risk factors for heart disease,” he says.
Smoking also may have a unique effect in people with HCM, narrowing the arteries that supply blood to the heart and worsening symptoms.
Do: Take Very Good Care of Your Gums and Teeth
Good dental hygiene is important for anyone managing a heart condition, says Schenone. He always recommends that his patients go to the dentist for both routine cleaning and any necessary maintenance, since this care can have an impact on heart-related outcomes.
When you have HCM, you may be at a higher risk for endocarditis, inflammation of the heart lining that’s caused by infection. Such infections can result from many sources, including poor dental hygiene and even dental procedures.
Schenone says it can be a good idea for people with certain heart conditions to take antibiotics prior to dental procedures to prevent infection.
Don’t: Use Illicit Drugs
Illicit drugs can take a toll on your body regardless of the presence of a heart condition. And when you’re living with HCM, illicit drug use has the potential to be even more dangerous. Schenone says that for people with obstructive HCM specifically, anything that increases the heart rate or increases the force of the heart muscle contraction promotes obstruction.
Cocaine use can increase both heart rate and contraction force, and using some amphetamines increases heart rate, in turn promoting LVOT obstruction, says Schenone. Methamphetamine is one addictive substance that increases heart rate in the short term and increases the risk of heart failure, stroke, and infective endocarditis in the long term.
Conversely, Schenone says that if a person with HCM uses illicit drugs that promote profound relaxation and result in a significant decrease in blood pressure, low blood pressure may become a risk factor for LVOT obstruction as well.
Do: Enjoy Regular Light or Moderate Exercise
Current guidelines from the American Heart Association and the American College of Cardiology encourage regular light to moderate exercise for people with HCM. These guidelines also note that some people with HCM may need to begin with an initial period of medically supervised physical activity.
Light-intensity exercise includes activities like slow walking. Moderate exercise includes activities like brisk walking, cycling, and yard work. While people with HCM can start with mild to moderate exercise, some can continue to do more and more as they improve their physical fitness, says Schenone.
Unfortunately, people with HCM can be more likely to lead a more-inactive lifestyle and are sometimes encouraged not to exercise. Still, if you’re not active now, feel free to talk with your healthcare team about beginning exercise training.
Don’t: Use Over–the–Counter Cold Medications
Decongestants can be helpful for easing uncomfortable cold symptoms — but when you’re living with a heart condition, check with your healthcare provider before taking them. Decongestants can sometimes increase blood pressure, and people with HCM can also have other health conditions like hypertension (high blood pressure), says Schenone.
The impact of certain cold medications on heart rate is important, too. Some contain phenylephrine or pseudoephedrine, which can promote an increase in heart rate, although minimally.
Schenone says that for people with HCM, decongestants may be used as a last resort and with caution. Instead, he recommends trying saline irrigation and using acetaminophen or ibuprofen to help manage cold symptoms.
The Takeaway
People with hypertrophic cardiomyopathy (HCM) should avoid heavy lifting, using hot tubs or saunas, smoking, using illicit drugs, and taking certain over-the-counter cold medications to protect their heart health and quality of life.
It’s also important for people with HCM to stay well-hydrated, enjoy regular light to moderate exercise, and maintain good dental hygiene.
Work closely with a healthcare team, including an HCM specialist, to receive personalized guidance and make informed decisions about your care and treatment for this heart condition.
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Vilcant V et al. Left Ventricular Outflow Tract Obstruction. StatPearls. December 23, 2022.
Ommen SR et al. 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. May 8, 2024.
D’Ascenzi F et al. Exercise Prescription in Cardiomyopathies: Rationale, Benefits, and Exercise Modalities. European Society of Cardiology. January 9, 2024.
Anurag Sahu, MD, is the director of the adult congenital heart program at Inova Health System in Fairfax, Virginia. Previously, he was an associate professor of medicine as well as an associate professor of radiology at Emory University in Atlanta, where he also served as director of cardiac intensive care.
He attended medical school at the University of Missouri in Kansas City in its combined six-year BA/MD program. He then completed his internal medicine residency at Washington Hospital Center in Washington, DC; fellowship training at Rush University in Chicago; and advanced training in cardiac imaging and adult congenital heart disease at The Ohio State University in Columbus.
Dr. Sahu has published book chapters on cardiovascular imaging as well as a variety of journal articles in publications including TheJournal of Heart and Lung Transplant, JACC: Cardiovascular Interventions, and the Journal of Thoracic Imaging.
Among the places that his career has taken him, his favorite was Kauai, Hawaii, where he was the only cardiologist on the island.
Jessica Freeborn has worked as a health and wellness freelance writer since 2021. She is passionate about encouraging people to take control of their health and stay informed about the latest medical advancements. She has two nursing degrees and has used her healthcare experience to enhance her writing and research.
As someone with type 1 diabetes, she understands the complexities surrounding diabetes management and wants to provide people with accurate information and dispel misconceptions about diabetes treatment.
