How is hypertrophic cardiomyopathy treated?
The 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.
Treatment for HCM can include drugs, surgery to remove a small amount of muscle from the ventricular wall or replace the mitral valve, alcohol septal ablation, (destroying some of the obstructive tissue) or implantation of devices to help control the hearet rhythm.
Treatment goals for HCM are primarily to prevent SCD and relieve discomfort and debilitating symptoms.
Some of the drugs used in treating HCM are: Beta-Blockers to slow the heart, calcium antagonists to reduce pain, anti-arrhythmic drugs, anticoagulants, diuretics to reduce fluid retention, and antibiotics to prevent infection.
If drug treatment is ineffective, surgery may be an option. In some cases a portion of the thickened heart muscle is removed widening the pathway for the outflow of blood. This surgery is called a myectomy. In other cases the mitral valve can be replaced with an artificial valve.
An alternative to surgery is an invasive procedure named alcohol septal ablation. The patient is catheterized and alcohol is injected into the heart (septum) through a small coronary artery. This destroys some of the excess muscle tissue that is blocking blood flow. These procedures are not recommended for younger HCM patients and should only be performed in a facility with a comprehensive HCM program – and by a highly experienced team of HCM medical experts.
Some diagnosed HCM patients are at a high risk for sudden cardiac arrest and SCD from HCM. These individuals may be best treated with an implantable device. The most effective of these devices used in high risk patients is the ICD or the Implantable Cardioverter Defibrillator. This compact generator is 2″X2″, does not require major surgery, and is capable of sensing potentially lethal arrhythmias and then introducing a shock to terminate them and restore normal heart rhythm. Many high risk children and young adults are effectively treated with the ICD.
Pacemakers may improve symptoms and reduce obstruction in some HCM patients, particularly those of advanced age. These devices are used when a slow heart rate is a result of the HCM blockage. At this time, medical technology has advanced to the point that those HCM patients who require a pacemaker are given a combination device that includes both a pacemaker and an ICD.