Re: Hypertrophic Cardiomyopathy

Posted By CCF CARDIO MD - CRC on August 03, 1998 at 09:37:27:

In Reply to: Hypertrophic Cardiomyopathy posted by Patrick Kirk on August 02, 1998 at 16:15:11:






I was diagnosed with IHSS 15 years ago.  I was placed on Verapamil 420MG per day and have done exceedingly well.  My septal wall thickness remained a constant 1.4 CM since diagnosis. I have been physically very active and consistently do 60 mile bike rides at a time.  I just recently visited my cardiologist who did the yearly echo. He informed me that the septal wall thickness increased from 1.4 CM to 2.0 CM in the course of a year.  The only thing I did different was change from an immediate release verapamil to a sustained release.  Could there have been a problem with absorabability.  He has mentioned if the thickness worsens that he would consider sending me for surgery. My heart is currently not obstructing its own blood flow and I have minimal mitral valve regurgitation.  I am also currently totally asymtomatic.  What is your advice.  Thank you  Pat






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Dear Patrick,
Topic Area: Cardiomyopathy
Thank you for your question.  I dont think that changing the type of release for your medication would have that dramatic an effect on your heart.  A possible explanation is the increased activity level.  It is well know that athletes will have some hypertrophy of the heart muscle.  The only way to test this hypothesis would be for you to stop your routine exercise for about 3 months and then repeat the echo.  If there is regression (decrease in the wall thickness) then the additional hypertrophy may be due to increased activity and not the HOCM.  Discuss this with your cardiologist and see what he/she thinks.  Below is some general information on HOCM you may find useful.
IHSS (Idiopathic Hypertrophic Subaortic Stenosis), now commonly referred to as HOCM (Hypertrophic Obstructive CardioMyopathy), is a congenital (meaning that it runs in families) condition that results in thickening of the heart muscle (hypertrophy), a increased pressure gradient (obstruction) across the outflow tract and a cardiomyopathy (abnormal function of the heart muscle).  
Symptoms of HOCM include shortness of breath, lightheadedness, fainting and chest pain. Some patients experience cardiac rhythm disturbances which in some cases may lead to sudden death.   Due to this possibility patients with this condition are advised to avoid competitive sports (normal activity levels are OK). The obstruction to blood flow from the left ventricle increases the work the ventricle must do, and a heart murmur may be heard.
The treatment of HOCM may be several fold.  Medications, such as beta blockers and calcium channel blockers, are often given to attempt to decrease the workload of the heart.  Surgery may be recommended in patients with very high pressure gradients in the heart.  In a septal myectomy he surgeon goes into the heart and removes part of the muscle that is obstructing the blood outflow.   A alternative procedure that is being developed here and at several other centers that avoids the need for surgery.  A catheter (tiny tube) is threaded through the leg to the heart and the blood vessels that supply the thickened heart muscle are identified and then closed off with a solution of alcohol.  This results in a thinning of that particular area of the heart.  Not all patients are eligible for this procedure and there are benefits and risks to both procedures.
The issue of sudden death is not addressed by surgical means but rather by the implantation of a device called a defibrillator.  This device is similar to a pacemaker and keeps track of the heart rhythm.  If it detects a life-threatening rhythm it delivers a shock of electricity to the heart to get it back into regular rhythm.  Once again, not everyone is eligible for this device and there are benefits and risks involved.
There is a cardiologist here who specializes in this condition and is an authority in the field.  His name is Dr. Harry Lever.   Those who are interested in making an appointment with him  may do so by calling the number below.
Additional web sites with information about HOCM are listed below.
http://www.americanheart.org/Heart_and_Stroke_A_Z_Guide/cmyopa.html
Information provided here is for general educational purposes only. Only your doctor can provide specific diagnoses and treatments. If you would like to be seen at the Cleveland Clinic, please Call 1 - 800 - CCF - CARE for an appointment at Desk F15 with a cardiologist.