Hypertrophic Cardiomyopathy Surgery
All videos, procedure text and graphics courtesy of the
Cleveland Clinic.
Click here
to learn about:
What is hypertrophic cardiomyopathy (HCM)?
Hypertrophic cardiomyopathy (HCM) is a complex type of heart disease marked by thickening of the heart muscle, left ventricular stiffness, mitral valve changes and cellular changes.
Hypertrophic cardiomyopathy may also cause thickening in other parts of the heart muscle, such as the bottom of the heart called the apex, right ventricle, or throughout the entire left ventricle.
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Normal Heart
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HCM
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normal cell
pattern
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disorganized
pattern
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Who is affected by hypertrophic cardiomyopathy?
HCM affects an estimated 600,000 to 1.5 million Americans, or one in 500 people. It is more prevalent than multiple sclerosis, which affects one in 700 people.
HCM is the most common cause of sudden cardiac death in people under age 30. HDCM may be best known for its role in cardiac arrest and subsequent death in some young professional athletes.
HCM can be:
Because the cause of HCM varies, it is frequently difficult to identify a high-risk population.
Many people with HCM have no symptoms or only minor symptoms, and live a normal life. Other people develop symptoms, which progress and worsen as the heart function worsens. Symptoms can occur at any age and may include:
The diagnosis of HCM is based on:
Medical history: Your doctor will ask you many questions about your symptoms and family history.
Physical exam: Your doctor will listen to your heart and lungs. Patients with severe hypertrophic obstructive cardiomyopathy (HOCM, or outflow tract obstruction) may have a heart murmur.
Tests: Echocardiogram is the most common test used to diagnose HCM, as the characteristic thickening of the heart walls is usually visible on the echo. Other tests may include blood tests, electrocardiogram, chest x-ray, echocardiogram, exercise stress test, cardiac catheterization and magnetic resonance imaging (MRI). Click here to learn more about these diagnostic tests and procedures
How is hypertrophic cardiomyopathy treated?
The type of treatment prescribed depends on:
Treatment is aimed at preventing symptoms and complications and includes risk identification and regular follow-up, lifestyle changes, medications and procedures as needed.
It is important to identify the small number of patients with HCM who are at higher risk for sudden cardiac death, so preventive measures can be taken. People with HCM who have a higher risk for sudden death include:
If you have two or more risk factors for sudden death, your doctor may prescribe preventive treatments such as antiarrhythmic medications or an implantable cardioverter defibrillator (ICD). Most people with HCM have a low risk for sudden cardiac death. Talk to your doctor about any personal concerns.
Medications
Often, medications are used to treat symptoms and prevent further complications. Medications help relax the heart and reduce the degree of obstruction so the heart can pump more efficiently. Beta-blockers and calcium channel blockers are two classes of medications that may be prescribed. If you have an arrhythmia, your doctor may prescribe medications to control your heart rate or decrease the occurrence of arrhythmias. Your doctor will discuss which medications are best for you.
Check
the
drug search to find out more about your medications.
It is important to know:
You may be told to avoid certain medications, such as nitrates because they lower blood pressure, or digoxin, because it increases the force of the heart’s contraction.
Antibiotic medications are prescribed to prevent bacterial endocarditis, a potentially life-threatening condition.
Procedures: septal myectomy, ethanol ablation, pacemaker, ICD
Septal
myectomy
During this surgical procedure, the surgeon removes a small
amount of the thickened septal wall to widen the outflow tract
(the path the blood takes) from the left ventricle to the aorta.
Myectomy is considered when medications are not effective in
treating HCM. This frequently eliminates the mitral valve
regurgitation. This procedure has a high percentage of positive
results.
Click here to see animation
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Ethanol
ablation
This procedure, also called septal ablation, is performed in
the cardiac catheterization laboratory. First, the small
coronary artery that supplies blood flow to the septum is
located during a cardiac catheterization procedure. A balloon
catheter is inserted into the artery and inflated. A contrast
agent is injected to locate the thickened septal wall that
narrows the passageway from the left ventricle to the aorta.
When the bulge is located, a tiny amount of pure alcohol is
injected through the catheter. The alcohol kills the cells on
contact, causing the septum to shrink back to a more normal size
over the following months, widening the passage for blood flow.
Click here to see animation
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before ablation - thick septum, narrowed outflow
tract
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balloon and tube inside septal perforator (blood
vessel) in swollen septum
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after ablation - normal outflow
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Implantable Cardioverter Defibrillators (ICD)
ICDs are suggested for patients at
risk for life-threatening arrhythmias or sudden cardiac death.
The ICD is a small device placed just under the skin and is
connected to wire leads that are threaded through the vein to
the heart. An ICD constantly monitors the heart rhythm. When it
detects a very fast, abnormal heart rhythm, it delivers energy
to the heart muscle to cause the heart to beat in a normal
rhythm again.
For
patients with non-obstructive HCM
Non-obstructive HCM symptoms may be treated with
medications. If heart failure occurs, treatment is aimed at
controlling it.
Lifestyle changes:
Diet:
Drinking at least six to eight, 8-ounce glasses of water a day is important, unless fluids are restricted. In hot weather, you should increase your fluid intake.
Fluid and sodium restrictions may be necessary for some patients if heart failure symptoms are present. Ask your physicians about specific fluid and dietary guidelines, including information about alcoholic beverages and caffeinated products.
Exercise:
Your doctor will tell you if you may exercise or not. Most patients with HCM are able to do noncompetitive aerobic exercise. Heavy weight lifting is not recommended.
Regular follow-up Visits:
Patients with HCM should have an annual follow-up visit with their cardiologist to monitor their condition, unless more frequent appointments are needed. Follow-up appointments may be more frequent when HCM is first diagnosed.
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What is endocarditis? Endocarditis occurs when germs (especially bacteria) enter your blood stream and attack the lining of your heart valves, causing growths on the valve, holes in the valve or scarring of the valve tissue, most often resulting in leaky heart valves. |
Prevention of Infection:
People with HCM may have an increased risk for developing infective endocarditis. Those at risk should follow these precautions:
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