Hello Ms XXXXXXX XXXXXXX
Thank you for your query.

Hypertrophic cardiomyopathy is a disease of the heart muscle, where there is significant increase in the thickness of some parts of the cardiac muscle. There are functionally two types - obstructive and non-obstructive. From the echo report, you have the obstructive type of disease, also called as HOCM in short.

Here the wall that separates the right and left pumping chambers of the heart has increased in thickness in such a manner that there is some degree of obstruction of the outflow of the blood from the heart.

This disease usually results from a mutation (change) in the genes that code for the proteins that make up the cardiac muscle.

Since it is a genetic disease, treatment options are somewhat of a palliative nature only and complete "cure" is not yet possible. However, the majority of patients do lead a relatively normal life with the help of medicines and rarely, interventional/surgical procedures.

The initial treatment is by using oral medicines - either a beta blocker or a calcium channel blocker. There are many drugs in each class and the choice of drug will be determined by your symptoms, analysis and preferences of your treating cardiologist. The goal of treatment is to relieve the symptoms like chest discomfort, breathing difficulty on exertion, palpitations, giddiness, etc. and also to prevent further increase in thickness of the muscle. After starting with a small dose, the dosage may need to be adjusted further depending on response.

If the patient remains symptomatic on optimal drug doses, one can consider an interventional procedure called septal ablation. This is done by injecting a drug (commonly ethyl alcohol) selectively into a branch of the coronary artery that is supplying the thickened part of the heart muscle. This produces a reduction in size of the muscle after a period of time and relieves the obstruction to blood flow. The procedure is done in the cathlab as a percutaneous procedure and does not involve open surgery. However, it carries a small risk of need for a pacemaker later on and possibility of some damage to the heart muscle.

In extreme cases, open surgery can be done with surgical resection of the extra muscle (myectomy) with or without mitral valve replacement. Your present condition does not warrant open surgery as of now.

In addition, HOCM can also be associated with rhythm disorders. Many cardiologists routinely screen the ECG and do a 24 hour holter recording to detect any arrhythmias. Treatment would depend on the arrhythmia present. You need to be seriously evaluated if there is any history of any related family member who had sudden collapse or unexplained sudden death.

As a general measure, it is recommended that you do not do any heavy exercise. Avoid lifting weights. Contact sports and participation in professional sports are to be avoided. Mild restriction of salt in the diet may be useful. There are usually no problems associated with pregnancy and childbirth.

I hope this answers your query. If you need any further clarifications, feel free to contact me.
With regards,
Dr RS Varma

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Hello,
Thank you for your reply.

Inderal or propranolol is a beta blocker and is used as a first line drug in the treatment of HOCM. You will need to uptitrate the dose of this medicine depending on the clinical response.

At 23 years of age, immediate angiography may not be required unless you are extremely symptomatic and there is no satisfactory response to the medicines. Angiography is also necessary if an intervention like septal ablation or surgery is being planned.

I would like to know what symptoms you are suffering from. Do you have chest pain, breathing difficulty or palpitations? Has a treadmill test or Holter monitor been done?

Dr XXXXXXX XXXXXXX at TCVS, Ahmedabad is among the leading cardiologists of India. He is located relatively close to you. If you need angiography and intervention, you can always seek his expert help.

If you can tell me your symptoms and the results of the treadmill/holter tests, I could advise you about further lifestyle changes and drugs. Whatever I have told you in the earlier post about the general measures should be followed.

I hope this answer helps you. Please contact me again with the details of your symptoms and the reports so that I can give you a more specific answer.
With regards,
Dr RS Varma

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Hi XXXXXXX


Thank you again for getting back to me.

After going through the symptoms description provided by you, I would suggest the following…

1. Up titrate (Adjust the dose of Propranolol) to improve your symptoms after discussing with your cardiologist. Or

2. Add a Calcium channel blocker to your current medications to relieve your symptoms, which would be decided by your cardiologist.

3. Depending upon the response to the adjusted doses of the medicine for over 3 to 6 months, a decision needs to be taken regarding the need for surgery.

4. You must undergo a treadmill test and Holter monitoring to objectively document the severity of symptoms and to see if there are any ventricular arrhythmias, so that it will help in deciding about the treatment modality best suited for you.

5. Symptoms during stress full situations like exams may be due to anxiety.

6. Regarding the timing of the surgery, the decision would be taken based on your response to the medical therapy, and if the medical therapy fails then only a surgical intervention needs to be done. Decision regarding timing of the surgery cannot be taken based on your timing of marriage.

7. The surgical intervention at any rate would only be palliative and not a curative measure as your condition is genetic in nature.

8. The type of surgical intervention would be decided based on your test results like angiography, echocardiography etc.

As I do not have experience with cardiologists in Mumbai or Kolkata, I will not be able to advice you regarding the doctors. All I can do to help you in this regard is that you can visit Hospitals like Apollo, Fortis or Any of the medical colleges in Mumbai since they are well equipped to undertake any intervention necessary for you.

I hope again that my suggestions were of help to you.

Wishing you good health.
Regards.

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