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HOCM Hypertrophic Cardiomyopathy Hypertrophic cardiomyopathy is a condition where the heart muscle becomes thickened.The symptoms that develop depend on the severity of the condition. The treatment depends on the type of symptoms you have and whether complications develop. Some people need no treatment. What is cardiomyopathy? Cardiomyopathy is a disorder of the heart muscle. There are four main types: Dilated cardiomyopathy - where the heart dilates (enlarges). Hypertrophic cardiomyopathy (HCM) - where the heart muscle becomes thickened (hypertrophied). Restrictive cardiomyopathy - where the heart muscle cannot relax properly between heartbeats. This is rare. Arrhythmogenic right ventricular cardiomyopathy - a rare type which mainly affects the right side of the heart. The rest of this leaflet is only about HCM. What happens in hypertrophic cardiomyopathy HCM the heart muscle becomes thickened (hypertrophies) in parts of the heart. In the normal heart, the muscle cells are regular and patterned. In HCM the cells of the heart muscle become irregular and disordered.The degree of thickening may vary in different places. The thickened heart muscle usually contracts well to pump blood out of the heart. However, it may lead to problems which include the following: The affected heart muscle may become stiff. This can mean that your heart may not fill as easily as normal. Less blood than normal is then pumped out from your heart with each heartbeat. Theremay partial obstruct the flow of blood from your heart which make the blood flow turbulent. Turbulent blood flow can make small blood clots more likely. The thickened heart muscle may affect the function of your heart valves. they may become leaky if it does not close properly. In some people, the abnormal heart muscle affects the electrical conducting system of the heart. This may cause abnormal heart rates and/or rhythms to develop. What causes hypertrophic cardiomyopathy? Heart muscle can thicken because of something, such as high blood pressure. In HCM the heart muscle thickens without an obvious cause.In most cases the condition is inherited. If a couple (where one person has HCM) has a child, there is a 1 in 2 chance of the child being affected. This pattern of inheritance is called autosomal dominant. It seems that affected people inherit defective genes which are involved in making parts of the heart muscle cells. Men and women are affected equally. What are the symptoms of hypertrophic cardiomyopathy? If you only have mild thickening of the heart muscle you may not have any symptoms Symptoms can range from mild to severe and may not develop straight away. Possible symptoms include the following: Shortness of breath. This may develop only when you exercise if the condition is mild. When the condition is more severe, you can be breathless at rest. Chest pain (angina). This may develop only when you exercise, but occur at rest when it is more severe. Palpitations. Sometimes abnormalities of heart rhythm (arrhythmias) develop which can cause palpitations. You may become aware that your heartbeat is fast and/or irregular. Dizziness and fainting attacks. These occur more commonly when you exercise, but may occur when you are resting. This may be due to reduced output of blood from the heart or because of arrhythmias. How is hypertrophic cardiomyopathy diagnosed? A doctor may suspect this condition because of: Your symptoms. Your family history. Changes on your electrocardiogram (ECG) - this is a tracing of the electrical activity of the heart. Changes on your chest X-ray. This may show your heart is large or that there is fluid in your lungs. An ultrasound scan of the heart. This is called an echocardiogram. How does the condition progress? The thickening of the heart muscle does not tend to progress once you stop growing. This means that, for many people, the symptoms remain stable during adulthood. Unfortunately, the symptoms gradually become worse for some people as the heart muscle becomes more stiff. Sometimes the function of the heart gradually deteriorates and heart failure may develop. Complications may occur and include the following: Arrhythmias: arrhythmia is an abnormal rate or rhythm of the heartbeat Endocarditis:This is a rare complication.Endocarditis is an infection of the inside lining of the heart chambers and heart valves. Sudden death:sudden collapse and death occurs in a small number of people with HCM. This is probably due to a severe arrhythmia which may develop suddenly. People most at risk are those with more severe disease, especially those who have had a previous serious arrhythmia. What is the treatment for hypertrophic cardiomyopathy? There is no treatment which can reverse the changes of the heart muscle. Treatment aims to ease symptoms if they occur and to prevent complications. If you do not have any symptoms or you only have mild symptoms then you may not need any treatment. Medication Beta-blockers and calcium antagonists are the commonly used medicines..These medicines are used to treat chest pain, breathlessness and palpitations. Various other medicines called anti-arrhythmic medicines are used to treat and to prevent arrhythmias. Warfarin may be advised if you develop atrial fibrillation (a common arrhythmia). With this arrhythmia a blood clot is a possible complication. Warfarin is an anticoagulant. This means it helps to prevent blood clotting by thinning the blood. Other types of treatment for arrhythmias Other treatments may be an option if you develop arrhythmias. For example: Cardioversion is an option for some types of arrhythmia. Whilst under anaesthetic, you are given an electric shock over the heart. This may revert the rhythm back to normal. Artificial pacemakers are used in certain types of arrhythmia where the heart beats abnormally slowly (complete heart block) and in certain other situations. Implantable cardioverter defibrillators (ICDs) are sometimes used in certain situations - especially if you are at risk of developing serious and life-threatening arrhythmias. The device monitors the heartbeat. If it detects an abnormal rhythm, the device can send a small electrical shock to the heart to change it back to normal. Surgery If your cardiomyopathy is severe, an operation may be option: Myectomy. This is an operation to remove a segment of thickened muscle from the septum to relieve obstruction of blood flow. It is done as open heart surgery. It is not a cure. Alcohol septal ablation. This is a fairly new technique. Alcohol is injected into the small arteries which supply the thickened area of heart muscle. This destroys that part of muscle, which then becomes thinner. Valve replacement may be needed if the valve is affected and does not work properly. A heart transplant may be needed in a small number of people. Some other general points Family testing (screening). Your first-degree relatives (mother, father, brother, sister, child) should have tests such as a heart tracing and an echocardiogram. Exercise. Depending on the severity of the condition, some people are advised not to take part in strenuous sports or jobs. Your doctor can advise you about this. Weight. Try not to become overweight, which can put an extra strain on your heart. Alcohol. Normal social drinking in moderation should not affect your heart. However, too much alcohol can affect the heart muscle and should be avoided.

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