Hypertrophic Cardiomyopathy is a condition of the heart in which a part of the myocardium or the muscle of the heart is enlarged without any obvious reasons. It is very common and affects people of all ages. It is the most common cause of sudden cardiac death in young people and affects both men and women equally. The condition is usually inherited and is believed to be a result of several problems with the genes that control heart muscle growth.
Cardiomyopathy is the collective name given to conditions affecting the muscles of the heart. Hypertrophic Cardiomyopathy is caused when the elements in the heart responsible for the contractile action replicate. This causes the cells of the heart muscle to increase in size eventually leading to the thickening of the heart muscle. This in turn disrupts the normal alignment of the muscle cells leading to a condition called myocardial disarray. It also disrupts the electrical system of the heart.
Myocardial Disarray i.e. the condition in which the alignment of muscle cells are disrupted.
Sometimes Hypertrophic Cardiomyopathy may block the proper flow of blood from the ventricle, this case is known as Obstrective Hypertrophic Cardiom In other cases the septum i.e. the wall separating the left and right sides of the heart, thickens and bulges into the left ventricle effectively blocking the flow of blood from the ventricle. And as a result of this blockage the ventricle must work harder to pump blood.
Hypertrophic Cardiomyopathy also affects the Heart’s mitral valve causing the blood to leak backward through the valve. In case where the enlarged heart muscle doesn’t obstruct the flow of blood out of the ventricle the condition is called non obstructive cardiomyopathy .
In both cases the thickened myocardium makes the inside of the left ventricle smaller and therefore it holds less blood. The walls of the ventricle may stiffen and the ventricle is not efficient in relaxing and filling with blood. Hypertrophic Cardiomyopathy causes increased blood pressure in the ventricles and the blood vessels in the lungs. This also causes changes to the cells in the damaged tissues of the heart. This causes defects with heart’s electrical signal and eventually leads to arrhythmias.
The associated symptoms of Hypertrophic Cardiomyopathy are :
- Shortness of Breath.
- Chest Pain
- Swelling in the ankles, feet, legs and abdomen.
Symptoms and complications vary from simple to severe. For instance complications like serious arrhythmias, inability to exercise, and extreme fatigue with little physical activity. Rarely people with Hypertrophic Cardiomyopathy are at risk of sudden Cardiac Arrest during vigorous physical activity. The death of many young athletes can be attributed to this.
Diagnosis procedure follows a physical exam by the doctor in which he listens to the patients’ heartbeat using a stethoscope. If this reveals abnormal heart sounds or a murmur he may prescribe further tests to check the muscle thickness, any problems with blood flow, or leaky valves. The following tests may be used:
- 24 hour heart monitor
- Cardiac Catheterization
- Chest X ray
- MRI of the heart
Sometimes blood tests may also be done to rule out the possibilities of any other diseases. Treatment for Hypertrophic Cardimyopathy starts with medication to help the heart relax and contract correctly. Drugs like beta blockers and calcium channel blockers are employed which reduce chest pain and relieve symptoms for patients whose disease condition is not severe. Anti-arrhythmic drugs are also used to prevent irregular heartbeats.
Sometimes severe complications like a blockage calls for surgical procedures. In that case an operation called surgical myectomy is done in which the thickened part of the heart is cut and removed. In case the mitral valve is leaking surgery is also conducted to repair the valve. Another procedure called alcohol septal ablation involves administering an injection of alcohol into the arteries that feed the thickened parts of the heart.
Implantable devices are also used frequently in the treatment of Hypertrophic Cardiomyopathy. Pacemakers though increasingly in less use today are used in some cases. When the patient is at risk of a sudden ardiac arrest the situation demands an Implantable Cardioverter Defibrillator. High risk classification includes those patients who:
- Experience a drop in blood pressure during exercise
- Have a family history of cardiac arrest
- Have severe heart muscle thickness
- Have a history of unexplained fainting
Hypertrophic Cardiomyopathy may cause many lifestyle changes for the patient. They may experience trouble in doing any form of physical exertion. In a majority of cases an affected patient has at least one close relative also who suffers from Hypertrophic Cardiomyopathy so when a patient is diagnosed all the close family members are also screened for the disease. There may also be a risk for affected parents having children, but then again the risk depends on their gene patterns.