Hypertrophic Cardiomyopathy (HCM) Treatment: Medication, Lifestyle, Surgery, and More

Hypertrophic cardiomyopathy (HCM) is a condition in which tissues in the heart become thickened, which can make it difficult for the organ to pump blood throughout the body.

HCM does not always have strong symptoms, but even mild cases require regular treatment to reduce the long-term risk of cardiovascular disease. The condition can worsen over time, so it’s important to keep follow-up appointments to monitor any changes and keep up with appropriate treatments.

“Treatment of HCM requires ongoing care with a cardiologist,” says Jeffrey Geske, MD, a cardiologist at Mayo Clinic in Minnesota, who specializes in HCM. “But with modern care, most patients with HCM have a normal lifespan.”

Beta-Blockers

Beta-blockers are pills that decrease blood pressure and heart rate, putting less tension on the heart wall. Medications in this class include:

• atenolol
• bisoprolol
• carvedilol phosphate
• metoprolol succinate
• propranolol

Calcium Channel Blockers

Similar to beta-blockers, calcium channel blockers, also known as calcium channel antagonists, reduce strain on the heart by lowering heart rate. Your doctor may try a calcium channel blocker if a beta-blocker was ineffective. For HCM, doctors prescribe nondihydropyridine calcium channel blockers, which do not significantly dilate the blood vessels, including:

• verapamil
• diltiazem

Anti-Arrhythmics

Anti-arrhythmics are medications that treat arrhythmias, which can develop as a result of HCM. The anti-arrhythmic most commonly used in HCM is a medication called disopyramide.

Blood Thinners

• warfarin (Jantoven)
• dabigatran (Pradaxa)
• rivaroxaban (Xarelto)
• apixaban (Eliquis)

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Blood thinners can cause excessive bleeding — including nosebleeds, bruising, and heavy menstrual periods — in addition to gastrointestinal problems, allergic reactions, headaches, and dizziness.

Cardiac Myosin Inhibitors

If surgery is necessary, having an operation “can result in dramatic improvement in how patients feel,” Dr. Geske says.

Septal Myectomy

Septal Ablation

A septal ablation, also called a septal myocardial ablation or alcohol septal ablation (ASA), is a minimally invasive procedure that uses alcohol to shrink thickened heart tissue.

“Alcohol ablation has the advantage of being less invasive than myectomy,” Geske says. During the operation, the surgeon guides a catheter into an artery that supplies blood to the thickened part of the heart and sprays alcohol on thickened tissue.

Heart Transplant

In very rare cases, patients with HCM can develop a weakened heart, sometimes called “burn out,” Geske says. These people may need implanted devices or a heart transplant.

Some people with HCM, particularly those who develop arrhythmias, may need an implanted device to keep their heart running well and to avoid cardiac arrest (when the heart stops beating).

Implantable Cardioverter-Defibrillator (ICD)

The implantable cardioverter-defibrillator (ICD) is the most frequently used implantable device in the treatment of HCM. It is used especially in patients with HCM who have arrhythmias that put them at risk for cardiac arrest, or who have a family history of cardiac arrest from HCM.

Cardiac Resynchronization Therapy (CRT) Device

Ventricular Assist Device (VAD)

“In HCM, the heart is too muscular,” Geske says. “Therefore, most patients with HCM have an extra strong heart, not a weak one. CRT and VADs are therapies used in most cases for weakened hearts, thus, they are rarely used in HCM.”

People with HCM may be at an enhanced risk of cardiovascular disease, and therefore should try to follow expert recommendations for a heart-healthy lifestyle, such as adopting a healthy diet and exercise habits.

Get Regular Exercise, but Avoid Short Bursts

“The first thing I tell patients is don’t be scared of exercising,” says Ningxin Wan, MD, a cardiologist at NewYork-Presbyterian Queens in Flushing, New York, and assistant professor at Weill Cornell Medicine. But your cardiologist may tell you to avoid types of exercise that could overstress your heart.

Aim for sustained, regular, moderate endurance exercises like cycling, elliptical, walking, and jogging. Anything that requires sudden bursts of straining isn’t good for people with HCM, Dr. Wan says.

“What we don’t recommend is exercise that requires intense bursts like heavy weight lifting, contact sports, or anything that needs the patient to suddenly move or strain themselves. That gives the heart a sudden exercise rather than sustained, which can aggravate obstruction,” she says.

You should also not exercise on a full stomach or right after eating, since a full stomach can put pressure on the heart and make symptoms worse during exercise.

Stay Hydrated

Dehydration can worsen HCM symptoms.

“When you are dehydrated it’s easier for the sick heart muscle to get in the way and obstruct blood flow,” Wan says.

Avoid Extreme Heat

Lose Weight, if Necessary

• HCM can seem mild or benign, but it is still important to see a cardiologist regularly, as treatment can help reduce the long-term risk of cardiovascular disease.
• Some people with HCM will need surgery or an implanted device, but these treatments are considered safe and effective.
• HCM does not need to strongly affect your quality of life, but your doctor may ask you to make some small adjustments, such as avoiding high-intensity exercise.