Obstructive Hypertrophic Cardiomyopathy

[Brenda__0__0]

  My sister is 41, she was diagnosed w/HOCM a little over 2 years ago.  Shortly after that she had a heart attack.
  After doing a cath, the docs say she does not have coronary artery disease.
  Her gradient after the MI was 60. Then after many meds, her gradient got
  much better.  Now she has been having a lot of chest pain so they
  repeated her stress echo and her gradient was between 60 and went up
  to 120 under stress after they gave her nitro.  The docs are talking
  about a dual chamber pacemaker but have some hesitancy as to whether
  this will work.  Are there any parameters under which these pacemakers
  have been found to be the most successful?  Also, how common  and
  tested is the alcohol ablation treatment?

[CCF Cardio MD - MTR]

_
Dear Brenda, thank you for your question.  HOCM is a difficult disease to treat, because patients with HOCM have a wide variety of symptoms and clinical findings.  If your sister's gradient did increase as you indicate, then a dual chamber pacemaker may help.  Clinical trials have shown that pacemakers may reduce the gradient and relieve symptoms in patients with HOCM.  However, some patients may not improve, but there are no good predictors to identify who will and who won't respond to dual chamber pacemakers.  Since pacemakers rarely cause patients with HOCM to get worse, it's probably worth a try if her physicians' recommend it.  Alcohol ablation remains an experimental procedure that is still being tested in tertiary medical centers.  At the present time, we are not sure which patients respond best to this form of treatment and what the long-term results are.  We have an expert on HOCM at CCF named Dr. Harry Lever.   You can reach Dr. Lever at the phone number listed below and he can provide you with more specific information about HOCM.  We offer both dual-chamber pacemakers and alcohol ablation at CCF for patients who are considered by our cardiologists to be good candidates for these procedures.

I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.  Good luck!
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.   The Heart
Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.