Hypertrophic cardiomyopathy can be difficult to diagnose. But thanks to advancements in treatment, many people can manage their HCM with minimal symptoms. Researchers at OHSU’s HCM Center of Excellence and beyond are developing new medicines like cardiac myosin inhibitors to treat the root cause of HCM.

Your treatment may include:

• Cardiac myosin inhibitors
• Other medications
• Implantable defibrillator
• Surgery
• Genetic counseling

Diagnosing hypertrophic cardiomyopathy

HCM can affect people differently, and not everyone’s symptoms look the same.

Your doctor may recommend one or more tests to help diagnose your HCM.

Echocardiogram: This test uses sound waves to make images of your heart’s size, structure and movement. This gives us information on how well it is working. It's a non-invasive, highly accurate and quick assessment of your heart’s health. This test is how we usually diagnose HCM.

Electrocardiogram (ECG): This test measures your heart’s electrical activity, including how fast it is beating and whether the rhythm is steady. This is a quick, painless test where electrodes (sticky patches) are placed on your chest, arms and legs. This is often the first test you’ll do if your provider suspects you have a heart condition.

Wearable monitors: Your doctor may have you wear a monitor to track your heart. There are two types of monitors we use. A Holter monitor is a wearable ECG device that records your heart’s electrical activity as you go about your activities. An event monitor is a wearable EKG that detects heart rhythm problems that don’t happen often. You will wear it for up to 30 days.

MRI: An MRI (magnetic resonance imaging) scan uses a strong magnetic field to create highly detailed, 3D images of your heart. An MRI helps your doctor confirm your diagnosis or better plan treatment.

Genetic counseling: To help find the cause of your hypertrophic cardiomyopathy, you may need a genetic test. HCM is a genetic condition that runs in families over generations. If you or your parent, sibling or child has HCM, then people in your family are at higher risk of the condition.

Hypertrophic cardiomyopathy treatment

There are many ways to treat hypertrophic cardiomyopathy. Your doctor will talk to you about your options and help you decide which is right for you.

Medications for HCM

Beta-blockers, calcium channel blockers and disopyramide: Many patients with HCM can manage their symptoms with these medications. Beta-blockers and calcium blockers slow down your heart rate or reduce the strength of your heart’s contractions to keep it working efficiently. Your doctor might prescribe a medication called disopyramide if other medications fail to control your symptoms of obstructive HCM.

Cardiac myosin inhibitors: These new medications are the first specifically developed to treat HCM. Cardiac myosin inhibitors are very effective because they target the root cause of HCM. They help your heart beat less forcefully, which can reduce your symptoms and make it easier for you to exercise. For now, these medications are approved for people with obstructive HCM.

Anticoagulants: An anticoagulant is a medication that prevents your blood from clotting or keeps existing blood clots from getting bigger. Common anticoagulants are heparin, warfarin, dabigatran, apixaban and rivaroxaban. If you have HCM, anticoagulants can keep harmful clots from forming in your heart, veins or arteries. Clots can block blood flow and cause a heart attack or stroke.

Surgery

If medications haven’t worked to manage your HCM, your doctor may recommend surgery called septal myectomy.

Implantable defibrillator: We will carefully evaluate whether you are at risk of dying suddenly from a dangerous heart rhythm. If your risk is high, your doctor will talk to you about an implantable defibrillator. An implantable cardioverter defibrillator (ICD) looks like a slightly larger pacemaker. An ICD senses when your heart is beating too fast and delivers an electrical shock to slow the rhythm. We also offer combined pacemaker and ICD devices for people who need both functions.

Septal reduction: In this surgery we remove a portion of the thickened heart muscle. There are two ways we can perform septal reduction. The first is alcohol septal ablation. In this minimally invasive procedure, we insert alcohol through a catheter to shrink part of your heart muscle. The second option is a surgical septal myomectomy, which is a major surgery that reduces the thickness of your heart muscle. Your doctor will only recommend major surgery if your HCM is serious and other treatments haven’t worked.

Other treatments for HCM

If you also have atrial fibrillation or heart failure, your doctor may refer you to other experts at the Knight Cardiovascular Institute to help manage your conditions.

Atrial fibrillation treatment: Some people with HCM also have atrial fibrillation, or AFib—an irregular or fast heartbeat. The Knight Cardiovascular Institute has many options to treat AFib. Your doctor can recommend the best treatment option for you.

Heart failure treatment: In advanced cases, we may recommend an evaluation by our heart failure experts. There are many ways we can treat heart failure, including medications, heart pumps or even a heart transplant.

Genetic counseling for HCM

We recommend genetic counseling if you or a family member are diagnosed with hypertrophic cardiomyopathy. A simple blood or saliva test can determine the risk of developing HCM. For anyone at risk, we recommend monitoring the heart—even if there are no symptoms.

Early detection and diagnosis can prevent, delay or lessen some HCM complications.

What to expect with genetic counseling

At your appointment, a genetic counselor will ask about your family’s history of heart problems.

The counselor will give you:

• Information about hypertrophic cardiomyopathy genetics
• An explanation of recurrence risks for family members
• Genetic testing and monitoring options
• Information about insurance
• Test results, if they’re available
• An explanation of what the results mean for you and your family

Genetic counselors also provide support and information about resources for people living with HCM and their families.

If you decide to proceed with testing, you will go to the laboratory for a blood draw. You can eat and drink normally before your appointment.

Learn more

• How to Screen Family for HCM, Hypertrophic Cardiomyopathy Association
• Diagnostic Journey, Hypertrophic Cardiomyopathy Association
• Treatment Journey, Hypertrophic Cardiomyopathy Association