Hypertrophic cardiomyopathy is the second most common disease of the heart and can occur without warning. It is common throughout all age groups and is very prevalent in today’s society. It is suspected to be an inherited genetic condition, but other risk factors like high blood pressure also can contribute to its development. It affects the heart muscles (myocardium) in particular and disrupts the functioning of the heart. The pathophysiology of hypertrophic cardiomyopathy involves the myocardium reaching a level of thickness that impedes with the basic efficiency of the heart. It is especially problematic when the walls of the left ventricle thicken. This thickening minimizes the blood supply that can enter the left ventricle and thus, the heart pumps less blood to the body. To compensate, the heart becomes overworked and there is an increased risk for cardiac arrest in all who suffer from hypertrophic cardiomyopathy. The prognosis of hypertrophic cardiomyopathy depends on which form it takes on, obstructive or non-obstructive cardiomyopathy. If blood flow is completely blocked through the left ventricle due to the thickening of the myocardium, it is termed obstructive hypertrophic cardiomyopathy. If blood flow is not blocked through the left ventricle, it is termed non-obstructive cardiomyopathy. Regardless, thickening of the myocardium occurs in both types.
Hypertrophic Cardiomyopathy Symptoms
As like any disease of the heart, hypertrophic cardiomyopathy symptoms are very dangerous and often impede on our daily lives. In general, hypertrophic cardiomyopathy symptoms depend on the area of the heart affected and the level of thickness of the surrounding myocardium. As mentioned previously, it is a genetic disorder and thus, the levels of mutation also affect the prevalence of symptoms. The common hypertrophic cardiomyopathy symptoms are chest pain, feeling faint or fainting, difficulty breathing and disorientation/dizziness. These symptoms are all related to the heart being overworked and having to compensate for the myocardial thickening in the heart. Children under the age of 2 can present symptoms of an irregular heartbeat (arrhythmias) that can drastically increase their chances of a heart attack. Also, infants and small children can present symptoms of sweating profusely and poor growth. In general, children do not notice the symptoms of hypertrophic cardiomyopathy until they reach puberty and start competing in more vigorous exercising and competitive sports. This is when hypertrophic cardiomyopathy and atrial fibrillation is accurately noticed. Thus, hypertrophic cardiomyopathy and exercise should be monitored if family members have a previous history of hypertrophic cardiomyopathy or heart disease. If you or your children have experienced any of the above hypertrophic cardiomyopathy symptoms, it is best to consult with a cardiologist or licensed medical practitioner immediately.
Hypertrophic Cardiomyopathy Risk Factors
Hypertrophic Cardiomyopathy risk factors predominantly include genetics.
If anyone in your family has suffered from hypertrophic cardiomyopathy, the chances of receiving the genes that encode myocardial thickness greatly increase. Thus, abnormal genes play a role in the pathophysiology of hypertrophic cardiomyopathy. If one of your parents has hypertrophic cardiomyopathy, the chances of developing it yourself are roughly 50%. It is imperative that your doctor be made aware of your family history to have a better prognosis of hypertrophic cardiomyopathy.
Other hypertrophic cardiomyopathy risk factors include aging, hypertension, diabetes, thyroid complication, alcoholism, and obesity. These all contribute to myocardial thickening and thus have the potential to elicit hypertrophic cardiomyopathy symptoms.
As humans get older, the likelihood of increased cholesterol in the bloodstream increases. Increased cholesterol, especially low-density lipoprotein (LDL cholesterol) is harmful as it contributes to the formation of atherosclerosis. Atherosclerosis is plaque build up in the arteries of the body. If atherosclerosis begins to develop in the coronary arteries, the heart begins to be overworked which contributes to increased myocardial thickness.
Hypertension is arguably the most preventable cause of heart disease today. Increased blood pressure is directly correlated with the heart becoming overworked. As the heart needs to work harder to pump the blood through the vessels of the body, the potential for myocardial thickening develops.
Studies have shown that up to 70% of people aged 65 and above that have been diagnosed with diabetes die from heart -related diseases. Diabetes results in having high blood glucose levels in the bloodstream. This is extremely damaging for blood vessels, which increased the likelihood of stroke and heart diseases.
The thyroid gland and the heart are indirectly linked to one another. In cases of thyroid disease, the thyroid releases excessive amounts of thyroxine. This hormone has been shown to increase the heart rate. Prolonged exposure to thyroxine can raise blood pressure leading to hypertension.
Alcohol has been shown to increase the fats in the bloodstream. This can lead to the development of atherosclerosis and the heart to become overworked.
Being obese is especially difficult on the heart. The excess mass directly enforces the heart to have to work harder to pump blood to the body. Also, obesity has been linked to higher cholesterol rates in the bloodstream and increased blood pressure. Both of these put an excessive workload on the heart and can lead to the thickening of ventricular walls. To better the prognosis of hypertrophic cardiomyopathy, one should strive to lose weight where they can.
It is imperative to minimize the hypertrophic cardiomyopathy risk factors to help achieve for better heart health.
Hypertrophic Cardiomyopathy Diagnosis
To better understand the course of action for hypertrophic cardiomyopathy treatment, an accurate diagnosis of severity must be made first. There are numerous tests to diagnosis hypertrophic cardiomyopathy. These include blood samples, x-rays, electrocardiograms, holter monitors, electrocardiography, stress tests. Some procedures include genetic testing, myocardial biopsy, coronary angiography, and cardiac catheterization.
Blood tests are often done to examine the levels of certain protein levels in the bloodstream. Troponin and creatine-kinase protein levels are commonly measured as they their levels indicate heart health.
Chest X-Rays are also another test that can be done to examine if hypertrophic cardiomyopathy treatment is needed. These X-Rays can identify if the heart has become enlarged due to myocardial thickening.
As the name implies, electrocardiograms are used to assess and monitor the hearts electrical impulses. The test helps determine if hypertrophic cardiomyopathy symptoms are present such as an irregular heartbeat or rhythm. Electrocardiograms are very common in helping to determine if hypertrophic cardiomyopathy treatment is needed.
A Holter monitor is essentially a smaller and portable electrocardiogram. These can be used in those where hypertrophic cardiomyopathy symptoms present themselves during daily activities such as exercising.
Echocardiography is a vital tool for examining heart health and disease. Echocardiograms help create a 3D picture of a heart to better understand the dimensions and thickness of the ventricular walls. They are often referred to as the gold standard for examining heart health.
Stress tests help study the heart under intense amounts of exercise and cardiovascular demand. Hypertrophic cardiomyopathy and exercise have shown to be positively correlated and thus it is better to examine heart health while exercising.
As the name implies, a licensed medical practitioner may elect to perform genetic testing to screen for abnormal genes linked to hypertrophic cardiomyopathy in family members. This helps generate a better prognosis of hypertrophic cardiomyopathy as preventative measures can be taken.
Myocardial Biopsy involves the removal of a small piece of myocardial tissue from the heart to be further examined in the laboratory. Changes to the tissues thickness and composition may help identify the early stages hypertrophic cardiomyopathy.
Coronary Angiography involves the input of a dye that can be seeing flowing through the coronary arteries and heart. This dye helps doctors better understand how the blood is flowing through your vessels and to see if any obstructions are present.
This procedure is invasive and allows trained medical professionals to examine the coronary arteries and the heart. A tube is inserted into a blood vessel, usually in the limbs, and monitored until it reaches the heart. As the tube moves to the heart, doctors can help examine for plaque build up and potential complications in the blood vessels of the body.
Hypertrophic Cardiomyopathy Treatment
Hypertrophic cardiomyopathy treatment is vital as the heart is absolutely critical to survive. Without treatment, the prognosis of hypertrophic cardiomyopathy is poor in more severe cases. Depending on the severity of the heart complications, doctors always elect to make lifestyle changes immediately to help prevent surgery for hypertrophic cardiomyopathy. Changes to diet and exercise are usually the first thing that doctors recommend. If the level of severity is too high for these, medications or surgery for hypertrophic cardiomyopathy may be used as a last resort.
Hypertrophic cardiomyopathy and exercise are linked. Not exercising enough promotes the build up of fatty plaque in the arteries that contributes to poor vessel and heart health. It is key not to overdue exercising, as hypertrophic cardiomyopathy and excessive exercise can trigger heart attacks and strokes. It is imperative to discuss with your doctor what the right amount of exercise is for the proper management of your heath.
Eating proper foods is also important for helping to correct hypertrophic cardiomyopathy and atrial fibrillation. Avoiding foods high in saturated and trans fat is key in developing healthy and plaque-free vessels. Also cutting the amount of sodium and sugar intake in the diet is vital in decreasing the risk for heart disease. Quitting smoking and alcohol while reducing stress has shown to increase heart and overall health as well.
Medications may also prevent surgery for hypertrophic cardiomyopathy. These include angiotensin II converting enzyme inhibitors, angiotension II receptor blockers, calcium channel blockers and beta-blockers. These medications help to lower blood pressure and increase heart health. Angiotension II related drugs help block the function of angiotensin II, which is promoting the construction of blood vessels and raising blood pressure. Thus, blocking the effects of angiotension II can lower blood pressure and dilate blood vessels. Calcium channel blockers, as the name implies, block the movement of calcium through the vessels of the body and indirectly lower blood pressure. Beta-blockers also lower blood pressure but block the binding of hormones such as epinephrine to the heart. Epinephrine promotes an increased heart rate and thus, without it, heart rate is decreased.
Surgery for Hypertrophic Cardiomyopathy
Surgery is often used as a last resort for hypertrophic cardiomyopathy treatment. Surgeons decide that it is needed for continued survival. Examples of common surgeries include: septal myectomy, implanted devices, and heart transplants.
This type of surgery is the most common amongst patients for hypertrophic cardiomyopathy treatment. It is only performed in patients that have severe symptoms and when medications are not working as well as they should. Septal Myectomy is a form of open-heart surgery and involves the removal of a large portion of the septum that is impairing with the function of the left ventricle. The myocardial tissue that is removed does not have stem cell-like abilities and cannot regenerate. The patient, without the portion of the septum blocking his or her left ventricle, is able to have increased blood flow through the left ventricle and thus, increased blood flow to the rest of the body. This greatly improves quality of life and eliminates symptoms in patients with hypertrophic cardiomyopathy when done correctly.
Surgeons may elect to insert certain devices that help improve the efficiency and functioning of the heart. A pacemaker is the most common example and helps to generate and maintain a proper heartbeat and rhythm. Another common device is a left ventricular assist device (LVAD). This device helps the left ventricle efficiently pump blood to the body and gives the left ventricular a electrical shock to help improve its functioning. A cardiac resynchronization device (CRT) may also be used in patients that have left and right ventricles that are not in sync. This device helps promote proper alignment and timing of both ventricles to increase efficiency of the heart.
If surgeons deem that heart may fail soon and contribute to cardiac arrest, heart transplant is needed. A heart from an organ donor is given to a patient that presents extremely severe symptoms of hypertrophic cardiomyopathy. Complications with heart transplants can happen, such as immune rejection of the donated organ, and thus it is used as an absolute last resort to treating heart disease.