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Hypertrophic Cardiomyopathy (HCM) Symptoms

Hypertrophic cardiomyopathy (HCM) is a common heart disease that causes the heart muscle to thicken, sometimes to the point of obstructing blood flow. HCM is not usually dangerous, but its symptoms, including chest tightness and shortness of breath, overlap with those of a number of more serious cardiovascular conditions and should be examined by a doctor. About half of people with HCM have no symptoms at all, or feel only mild symptoms occasionally.

The hearts of people with hypertrophic cardiomyopathy are thicker, and must beat more forcefully to pump out blood into the body. This can lead to a variety of symptoms, which may appear only occasionally.

Potential symptoms of HCM include:

  • Tightness in the chest or chest pain
  • Shortness of breath
  • Abnormal heart rhythms or palpitations
  • Fatigue
  • Dizziness or lightheadedness
  • Fainting
  • Swelling, especially in the lower body

“Because the symptoms of HCM can occur with many other disease conditions, recognizing HCM can be challenging,” says Jeffrey Geske, MD, a cardiologist at Mayo Clinic in Minnesota. There is no single hallmark symptom that indicates a person has HCM.

Some people with HCM will never experience any symptoms or notice any impact on their quality of life. In these cases, a diagnosis may be made during a routine heart health checkup, or if a family history of the disease has prompted screening. It is possible to live with HCM for decades before it is identified by a doctor.

There are two main types of HCM: obstructive and nonobstructive. Though both types can impact how well the heart functions, they differ in how much they obstruct blood flow out of the heart. The two types share the same symptoms and require similar treatments.

Obstructive Hypertrophic Cardiomyopathy 

Two-thirds of people with the condition have obstructive HCM. In these cases, the thickened part of the heart blocks and reduces blood flow.

This obstruction is considered a primary cause of symptoms in HCM, and obstructive HCM is thought to be more likely to lead to severe cardiovascular issues.

Nonobstructive Hypertrophic Cardiomyopathy

About one third of people with the condition have nonobstructive HCM, in which blood flow out of the heart is not blocked. Nonobstructive HCM may still reduce the amount of blood the heart can pump into the body with each heartbeat, though, because of the thickening and stiffening of the heart muscle.

In rare cases, nonobstructive HCM can lead to serious cardiovascular outcomes, such as heart failure, sudden death, and stroke.

For many people, HCM is a benign condition and it will not lead to dangerous cardiovascular disease, says Ningxin Wan, MD, a cardiologist at NewYork-Presbyterian Queens and an assistant professor at Weill Cornell Medicine. But that does not mean people who do not have symptoms should ignore follow-up appointments meant to monitor the condition, she says. Regular evaluation and preventive treatment is key to making sure that HCM doesn’t lead to a bad outcome.

“People who have HCM can live a normal lifestyle, unlike other heart diseases that really affect longevity, given that it is recognized and treated early on,” Wan says.

It’s also important to pay attention even to mild symptoms, and how they change over time.

“If I can get one message out to these patients it’s that we have treatments to help with symptoms and if you do not have symptoms, please do not forget that this is a condition that could get worse, and you need to monitor it,” Wan says.

Even people who do not experience symptoms should see a cardiologist regularly, as untreated HCM can increase the likelihood and severity of other cardiovascular issues, such as heart failure and arrhythmia (abnormal heartbeat).

Sudden Cardiac Death

The most severe complication of HCM is sudden cardiac arrest, in which the heart suddenly stops beating. Without emergency treatment, sudden cardiac arrest will result in death.

Although sudden cardiac death is the most well-known effect of HCM, it is rare, affecting about 1 in 3,000 people per year. Most such deaths occur in people who were unaware that they had the condition. This phenomenon is often associated with college-age athletes, though it doesn’t necessarily occur during exercise, and it can occur at any age.

HCM treatment, which may include the use of an implantable cardioverter-defibrillator (ICD), can greatly reduce the risk of sudden cardiac arrest.

If you experience any symptoms that could be related to HCM, you should see a doctor, even if those symptoms are mild. Geske highlights the following warning signs as good reasons to get in touch with your healthcare provider:

  • Any atypical shortness of breath when exercising
  • Chest pain
  • Abnormal heartbeat
  • Lightheadedness

“Any of these is enough to seek medical attention,” says Geske. A primary care physician or family doctor can begin the process of diagnosing what heart condition you may have.

Most HCM cases are caused by an inherited genetic mutation. Heart health authorities recommend screening people with a family history of HCM, even if they do not have any symptoms. Doing so can catch HCM and possibly prevent sudden cardiac death.

  • The symptoms of hypertrophic cardiomyopathy (HCM) — including chest pain or shortness of breath during exercise, lightheadedness, fatigue, dizziness, and abnormal heart rhythms — overlap with those of many other heart-related conditions.
  • Though HCM is often benign, it can sometimes lead to more serious complications, such as arrhythmia.
  • Not everyone with HCM has symptoms, but everyone with the condition should have their heart health regularly monitored by a cardiologist.
  • HCM is usually a hereditary disease. If you or a family member has a family history of HCM, you should ask your doctor about screening for the condition.

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