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Treatments and drugs
By Mayo Clinic staffThe goals of treatment for hypertrophic cardiomyopathy are to relieve symptoms and prevent sudden cardiac death in those at high risk.
Treatment options for hypertrophic cardiomyopathy include drugs, surgery or other methods to destroy obstructive heart tissue or implantation of devices to help control heart rhythm.
- Drug treatment. Various medications can help relax the muscle and slow the rate so that the heart can pump more efficiently. Some of the drugs your doctor may suggest include beta blockers, calcium channel blockers or the anti-arrhythmic medications disopyramide or amiodarone.
- Septal myectomy. This is an open-heart operation in which the surgeon removes part of the thickened, overgrown heart muscle wall (septum) that separates the two bottom heart chambers (ventricles). Removing part of this overgrown muscle improves blood flow and reduces mitral regurgitation. Myectomy is used if medications don't relieve symptoms. Most people who have symptoms and undergo myectomy have no further symptoms. This type of surgery is available only in medical centers that specialize in the treatment of hypertrophic cardiomyopathy.
- Septal ablation. Also called septal alcohol ablation, this is a treatment in which a small portion of the thickened heart muscle is destroyed by injecting alcohol through a catheter into the artery supplying blood to it. There are possible complications with this procedure, including heart block — a disruption of the heart's electrical system — which requires implantation of a pacemaker.
- Pacemaker implantation. A pacemaker is a small electronic device inserted under your skin that sends electrical signals to your heart to monitor and regulate your heartbeat. Surgery to implant the pacemaker is usually performed under local anesthesia and typically takes less than three hours. Pacemaker implantation is generally not as effective as surgical options, but it's sometimes used in older people who want to avoid more invasive procedures.
- Implantable cardioverter-defibrillator (ICD). This is a pager-sized device implanted in your chest like a pacemaker. An ICD continuously monitors your heartbeat. If a life-threatening arrhythmia occurs, the ICD delivers precisely calibrated electrical shocks to restore a normal heart rhythm. Some people with hypertrophic cardiomyopathy are at risk of sudden cardiac death because of abnormal heart rhythms. In these high-risk individuals, many doctors recommend the implantation of an ICD.
People with hypertrophic cardiomyopathy who may be candidates for ICD implantation include those with:
- Prior cardiac arrest
- One or more family members with sudden death caused by hypertrophic cardiomyopathy
- Unexplained fainting
- Episodes of rapid heartbeat
- Blood pressure that fails to rise during exercise testing
- An echocardiogram that detects extreme thickness of the left ventricular wall
References
- Hypertrophic cardiomyopathy. American Heart Association. http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_312225.pdf. Accessed Dec. 7, 2010.
- Elliot PM. Clinical manifestations of hypertrophic cardiomyopathy. http://www.uptodate.com/home/index.html. Accessed Dec. 7, 2010.
- Gemignani AS, et al. Cardiomyopathy, hypertrophic. In: Ferri FF. Ferri's Clinical Advisor 2011: Instant Diagnosis and Treatment. Philadelphia, Pa.: Mosby Elsevier; 2011. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-0-323-05610-6..00012-3--sc23005&isbn=978-0-323-05610-6&type=bookPage§ionEid=4-u1.0-B978-0-323-05610-6..00012-3--sc23005&uniqId=228752326-3. Accessed Dec. 7, 2010.
- Maron BJ. The 2009 International Hypertrophic Cardiomyopathy Summit. The American Journal of Cardiology. 2010;105:1164.
- Elliot PM. Diagnosis and evaluation of hypertrophic cardiomyopathy. http://www.uptodate.com/home/index.html. Accessed Dec. 7, 2010.
- Maron BJ. Hypertrophic cardiomyopathy. Circulation. 2002; 106:2419.
- Grogan M (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 12, 2010.
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