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    Hypertrophic Cardiomyopathy: Symptoms, Causes, Treatment And Prevention

    Hypertrophic cardiomyopathy (HCM) is a condition in which the myocardium or the heart muscle becomes thicker than its normal size. The increase in the myocardium thickness interferes with the heart's ability to pump blood. The condition causes the heart to pump less blood, thereby, hindering with the functioning of your body [1] .

    With the thickening, the ventricle mostly remains in its normal size but will cause a restriction in the regular flow of blood from it. Commonly, the condition does not show any symptoms, asserting that HCM does not pose any restriction in the lives of some individuals. However, in severe cases, the condition can result in individual developing symptoms such as heart failure and even cardiac arrest [2] .

    Hypertrophic Cardiomyopathy

    HCM is a very common condition and can affect anyone, irrespective of their age. It affects one in 500 people. The condition is, in most cases, inherited from the parents. It is one of the major cause of sudden cardiac arrest in young people. HCM is common amongst young athletes, and equally affects both men and women [3] . People with HCM have normal life expectancy.

    Other Names Of Hypertrophic Cardiomyopathy

    • Asymmetric septal hypertrophy [4]
    • Familial hypertrophic cardiomyopathy
    • Hypertrophic non-obstructive cardiomyopathy
    • Hypertrophic obstructive cardiomyopathy
    • Idiopathic hypertrophic subaortic stenosis (IHSS)

    Types Of Hypertrophic Cardiomyopathy

    HCM is of two types, which are the most commonly diagnosed ones [5] , [6] .

    Obstructive hypertrophic cardiomyopathy

    In individual suffering from this condition, the walls between the bottom chambers of the heart, that is, the left and right ventricle becomes thick and blocks the free flow of blood from the heart into the body. As the condition causes an obstruction in the normal flow of blood, it is called by the name obstructive hypertrophic cardiomyopathy.

    Non-obstructive hypertrophic cardiomyopathy

    In an individual with non-obstructive HCM, the left ventricle becomes thickened. It poses difficulty for the ventricle to fill enough blood that has to be pumped out into the body. The condition does not cause the obstruction directly, yet poses the same difficulty.

    Symptoms Of Hypertrophic Cardiomyopathy

    Usually, an individual with HCM will not experience any signs of the condition. However, some of the symptoms that can develop are as follows [7] :

    • Shortness of breath
    • Chest pain
    • Fainting
    • Heart murmur
    • Dizziness

    The above-mentioned symptoms arise upon doing any physical activity, such as exercise.

    The following symptoms can arise at any point in time [8] , [9] .

    • Fatigue
    • Shortness of breath
    • A sensation of rapid, fluttering or pounding heartbeats (palpitations)
    • High blood pressure
    Hypertrophic Cardiomyopathy

    When To See A Doctor

    If you experience the following signs and symptoms, it is crucial that you go to a hospital immediately.

    • Difficulty breathing
    • Rapid or irregular heartbeat
    • Chest pain
    Click here to check your possibilities of developing heart risks.

    Causes Of Hypertrophic Cardiomyopathy

    HCM is usually caused by gene mutations. The condition develops as a result of abnormal genes, which causes the abnormal thickening of the heart muscles. An inherited condition, there is a 50 per cent chance that the child will develop the condition if one of the parents are affected by HCM [10] . However, even if one inherits the disease, it is not necessary that they will show the symptoms.

    Individuals with HCM have been reported to possess an abnormal arrangement of heart muscles, called myofibre disarray.

    Apart from genetics, factors such as ageing and high blood pressure can also contribute to the development of the condition. And, the severity of the condition varies according to the type (obstructive and non-obstructive) of HCM [11] .

    Complications Of Hypertrophic Cardiomyopathy

    Although HCM is said to pose no signs that cause severe health problems, it can cause severe complications in some people [12] , [13] , [14] .

    1. Sudden cardiac death

    Ventricular fibrillation and ventricular tachycardia can result in sudden cardiac arrest. Individuals suffering from HCM has a higher chance of having sudden cardiac arrests, even though it is rare as it occurs to 1 per cent of people with HCM (every year). The condition can cause people of any age to have a cardiac arrest, although it is commonly viewed in individuals under the age of 30.

    2. Atrial fibrillation

    The abnormal structure of heart cells, as well as the thickened heart muscle, can cause disruptions in the normal functioning of the heart's electrical system. It can also increase the risk of developing blood clots that can travel to the brain, resulting in strokes.

    3. Dilated cardiomyopathy

    With time, the heart muscle can become ineffective and weak. This is rare, but, causes the ventricle to become dilated and hinders with its pumping ability.

    4. Obstructed blood flow

    This complication can cause shortness of breath, exertion, chest pain, dizziness and fainting spells.

    5. Mitral valve problems

    With HCM causing the heart muscles to thicken, it results in shrinking the space for proper blood flow. As there is a lack of space, the blood will be rushed through the heart valves forcefully. An increase in the force can prevent the valve between your heart's left atrium and left ventricle (mitral valve) from closing. Therefore, causing the blood to leak back into the left atrium (mitral valve regurgitation) [15] .

    6. Heart failure

    Eventually, the thickened heart muscle becomes too stiff to be filled with blood. This results in the heart being unable to pump enough amount of blood required for the proper functioning of your body [16] .

    Diagnosis Of Hypertrophic Cardiomyopathy

    Once you go to the hospital, the doctor will carry out a number of tests so as to examine and understand your condition. The doctor will review your medical history, as well as your family's so as to understand if anyone in your family has HCM [17] , [18] , [19] .

    1. Physical examination

    Under this test, the doctor will examine if you have unusual heartbeats or heart murmurs. This will help the medical practitioner in understanding whether any thickening has developed in the ventricle.

    2. Echocardiogram

    The most common diagnostic method used for HCM, the imaging test allows the doctor to see whether the heart muscle has become abnormally thick, obstruction in the blood flow as well as the functioning of the heart valves. Echocardiogram develops images of the heart using sound waves, which will help in understanding any unusual movements.

    The doctors will conduct a transthoracic echocardiogram or a transesophageal echocardiogram, depending upon the condition of your heart valves.

    3. Electrocardiogram (ECG)

    Under this test, electrodes that are attached to adhesive pads on your skin will measure the electrical impulses from your heart. An ECG will help detect the abnormal heart rhythms and enlarged chambers in the heart [20] .

    4. Cardiac MRI

    This test will use radio waves and magnetic fields to develop images of the heart. Often, cardiac MRI is used in addition to echocardiograms, so as to evaluate individuals with hypertrophic cardiomyopathy.

    5. Holter monitor

    This test will require you to wear a portable ECG, which will record your heart's activity continuously for a period of two days. A Holter monitor is usually used on individuals with hypertrophic cardiomyopathy.

    6. Cardiac catheterisation

    This test is carried out to measure the pressure of blood flow in the heart, as well as to check for blockages. A catheter is inserted into a blood vessel in the neck or the groin area. Using an X-ray machine, the catheter will be inserted into the heart chambers through the arteries [21] .

    7. Treadmill stress test

    You will be asked to walk on a treadmill, while your blood pressure, heart rhythm, and breathing will be monitored. The test will help the doctor in evaluating the symptoms, as well as analysing if physical activities such as exercise will cause abnormal heart rhythms. A treadmill stress test is done with echocardiography for individuals with severe symptoms of HCM [22] .

    Some of the other tests involved in the diagnosis of HCM are family screening, which will include genetic testing or an echocardiogram.

    Hypertrophic Cardiomyopathy

    Treatments For Hypertrophic Cardiomyopathy

    Medical care for HCM focuses on managing the symptoms as well as the complications that may arise. The treatment methods adopted for the condition depends on the symptoms, age, heart functions and the activity level of the individual diagnosed. The options of treatment for HCM include [23] , [24]

    1. Medications

    You will be prescribed with medicines that help relax your heart muscle, also to slow your heart rate. Therefore aiding your heart in pumping the blood more effectively. The doctor will recommend you medications to control the heart rhythm such as amiodarone or disopyramide , beta blockers such as metoprolol, propranolol or atenolol , calcium channel blockers such as verapamil or diltiazem .

    The doctor may prescribe you with blood thinners so as to reduce the risk of blood clots.

    2. Septal myectomy

    An open-heart surgery, the process involves removing the thickened part of your heart, which is the overgrown septum between the ventricles. This helps improve the blood flow and reduce the mitral regurgitation. The approach used by the surgeon can vary depending on the location of the thickened heart muscle.

    This process is done in the case if the medications fail to manage and reduce the symptoms.

    3. Septal ablation

    Under this method, a small portion of the thickened heart muscle is removed by injecting alcohol through a catheter into the artery that supplies blood to that area. Septal ablation is done on individuals who are not able to have a septal myectomy.

    4. Implantable cardioverter-defibrillator (ICD)

    If the individual has life-threatening heart rhythm disorders such as ventricular tachycardia or ventricular fibrillation, the doctor may recommend an ICD. The ICD, a small device, measures your heartbeat continuously and is implanted in your chest like a pacemaker [25] .

    5. Pacemaker Implantation

    In the case of irregular heart rate and rhythm, a small electronic device called as the pacemaker will be placed under the skin on your chest. The device helps in regulating your heart rate by sending electrical signals to the heart.

    Prevention Of Hypertrophic Cardiomyopathy

    As the condition is inherited, there is a lack of preventive measures. However, it is critical that once you are diagnosed with HCM, get the proper treatment as it will help limit the development of further complications [26] , [27]

    One of the preventive measures you can adopt in the case of HCM is by preventing death due to the sudden onset of cardiac arrest. By implanting a cardioverter-defibrillator, you can limit the onset of death caused by cardiac arrest.

    Doctors advise people diagnosed with HCM to avoid physical activities such as running, competitive sports as that require the heart to function excessively.

    Lifestyle And Home Remedies For Hypertrophic Cardiomyopathy

    By adopting certain changes in your daily lifestyle, you can help reduce the risks and complications pertaining to the condition. The most effective home remedies and lifestyle changes for HCM as advised by doctors are as follows [28] , [29] , [30] :

    • Eating a healthy diet, as it helps in maintaining the health of your heart.
    • Getting physical activity is a must, but make sure that you do not exert yourself by taking part in competitive sports. Get your body moving by taking up low- to moderate-intensity exercise with the help of your doctor.
    • Maintaining a healthy weight is critical because it will help prevent excessive stress on your heart, thereby reducing and limiting the onset of health risks.
    • Reducing alcohol consumption is important because it can trigger irregular heart rhythms that can cause increased blockage of blood flow in your heart.
    • Taking your medications without fail.
    • Having regular medical appointments, as it helps the doctor in properly analysing your condition.
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