Treatments for HCM
Medical Management for HCM
After a comprehensive evaluation, a cardiologist determines what medications will be most effective in addressing a patient's individual symptoms. Beta-blockers and calcium channel blockers can relieve certain symptoms, as can diuretics and anti-arrhythmia drugs.
We also provide patients and family members with lifestyle counseling which addresses activities to avoid because they stress the heart, diet and nutrition, and the level of exercise to support general health and well-being.
An important component of medical management is genetic testing—both for the patient, and first-degree relatives. While HCM cannot be treated with gene therapy, genetic tests can help us identify those family members who may carry a gene that causes HCM.
Using risk stratification, we can also advise patients who are likely to benefit from a pacemaker or implantable cardioverter defibrillator (ICD).
Interventional Procedures
Our physicians are among the most experienced in the world in septal ablation, a minimally invasive procedure that is done in a catheterization lab.
In this procedure, an interventional cardiologist injects a small amount of alcohol into the septal artery, destroying a small portion of heart muscle that's responsible for the obstruction. This results in improved blood flow.
This option is generally recommended for those too ill to undergo open surgery. Between five and 10 percent of patients who undergo ablation subsequently require pacemakers.
Pacemakers and Defibrillators
An implantable cardioverter defibrillator (ICD) is indicated if a patient has two of the following risk factors:
- A family history of sudden cardiac death
- A history of fainting or losing consciousness
- A heart wall that's more then three centimeters thick (one centimeter is normal)
- A non-sustained ventricular tachycardia (NSVT) appearing on a heart monitor
- A decline in blood pressure during exercise
These devices are very sturdy and effective. They can be used as a preventive measure in patients who are at risk for sudden cardiac death or to control life-threatening arrhythmias.
It generally takes between one and two hours to prep the patient and perform the implant. The patient is usually discharged the following day.
A subset of patients who have a procedure called septal ablation may require a pacemaker, because the surgeon is working in an area that contains the biological wiring of the heart.
Surgical Procedures
Septal myectomy, a surgery that excises damaged muscle tissues from the ventricular wall, has long been considered the gold standard to relieve obstruction in the hypertrophic heart.
In recent years, our surgeons have learned more about the anatomy of the hypertrophic heart, enabling them to excise enough of the heart muscle to relieve obstruction while minimizing adverse consequences.
Data also suggests that myectomy is associated with a greater relief of symptoms, greater reduction in the gradient (the difference in pressure between the left ventricle and the aorta), and may have provide more durable results than septal ablation.
Higher survival rates are reported in centers that perform the highest volume of these surgeries. Hiroo Takayama, MD, PhD, is one of the most experienced surgeons performing septal myectomy today.