KOCHI: Hypertrophic cardiomyopathy (HCM) is a common heart condition wherein the heart muscles get thicker, causing heart chambers to become small and thereby makes it difficult for the heart to pump oxygen and blood. HCM can be effectively managed with early detection, comprehensive evaluation and appropriate treatment.
"Earlier, the frequency was said to be one in 730 people. Now, studies show that it is more frequent, that is, one in 500 people. With technological advancements, awareness, and diagnostic criteria, the disease can now be easily detected," said Dr Rajashekhar, senior consultant, of interventional cardiology, at Aster Medcity.
Causes
Hypertrophic cardiomyopathy is caused by genetic variations in certain genes leading to abnormalities in some ultrastructural components of the heart muscles. "It is a genetic disorder in some cases. In such cases, we advise the family to get screened. It is better to screen if there is a family history," said Dr Rony Mathew Kadavil, head of cardiology at Lisie Hospital. He added that there is an acquired form as well.
Pressure, hypertension and stress can also lead to thickness of heart muscles to increase, added Rajashekhar.
Diagnosis
Patients can be identified with the disease at any age, from infancy to old age, according to Dr Hisham Ahamed, clinical lead at Amrita Cardiovascular Genomics Clinic. "HCM can be diagnosed using various methods such as electrocardiogram, echocardiogram, magnetic resonance imaging, and exercise or stress testing. Fortunately, diagnosing HCM is usually not difficult," he said.
The early symptoms of hypertrophic cardiomyopathy include, shortness of breath, chest pain, dizziness, fatigue, irregular heartbeats and palpitation
Not every patient has a symptom. Most of them are silent. "The presence of the disease is revealed when they have chest pain or when they faint. The majority of the patients come to us with symptoms of breathlessness," said Hisham.
There are several types of HCM, which can be classified according to the area affected. “Primarily, we consider two types, obstructive and non-obstructive. In obstructive form, as the thickness of the muscles has increased, the heart does not allow the blood to get pumped. It is more dangerous because they have more symptoms. The non-obstructive form may not have many symptoms," added Rony.
Treatment
Treatment depends on what type of cardiomyopathy the patient has. "If the patient has only the thickness and difficulty breathing, then medicines like beta blockers and calcium channel blockers are used to treat the disease," said Rony.
Lifestyle modification can help to an extent. "Avoid competitive sports. For people with HCM, exercise is a risk factor. They can follow low-intensity exercises. Avoid extreme temperatures as well," said Rajashekhar, adding that if the patient is suffering from obstructive type cardiomyopathy, the abnormal thickness can be reduced with an injection of absolute alcohol into the first septal artery supplying the basal part of the interventricular septum. Radio Frequency ablation can also be used and is safe.
"Placing an implantable cardioverter-defibrillator (ICD), a device that monitors the heartbeat and stops the abnormal beat, is also useful for patients. The method is decided upon the preference of the patient," Rony said.
"Surgical methods are also available to treat the disease if it can’t be managed with medicines. In older age, surgery would be more risky," added Rajashekhar.