Re: Hypertrophic obstructive cardiomyopathy

[Pat__0__0]

Posted By Pat on April 23, 1999 at 18:48:40
I was diagnosed with Hypertrophic obst. cardiomyopathy 15 years ago and now am going to have a septal myectomy.  I have a septal thickness of 2.2CM and a resting gradiant of 20 with a provocable gradiant of over 150.  I have mild mitral regurgitation with no other arrythmia.  My symptoms are not severe.  Some shortness of breath with exercise, mild chest pain at times and some dizziness with exercise.  My main symptom which I find troublesome is the fatigue.  My question basically is will the septal myectomy relieve this symptom.  I have received many different answers to this question. Thank you in advance for your response.

[Cleveland Clinic, MD]

Posted By CCF CARDIO MD - CRC on April 26, 1999 at 13:55:40

Dear Pat,
Topic Area: Cardiomyopathy
Thank you for your question.  Are you taking any medicines currently for your HOCM? Have you ever had atrial fibrillation?   All of these questions are taken into consideration in designing a treatment plan for patients with HOCM.  It may be that a surgical course or the new minimally invasive alcohol ablation of the septum is the best course of action.  If you are not already seeing a specialist in HOCM I would recommend you seek one out.  Dr. Harry Lever here is a world expert in this condition and I would highly recommend him if you wish to come to Cleveland.  Below is some general information about HOCM.
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.
Additional web sites with information about HOCM are listed below.
http://www.americanheart.org/Heart_and_Stroke_A_Z_Guide/cmyopa.html
HOCM Support group
http://www.kanter.com/hcm/
National Organization for rare diseases
http://www.rarediseases.org/
HOCM of Canada
http://www.cadvision.com/hcmac/hcmac.html
Mayo Clinic HOCM Clinic
http://www.mayo.edu/cv/wwwpg_cv/hocm_cln/hocm.htm
Article on septal ablation
http://www-east.elsevier.com/jac/3102/jac5431fla.htm
More info
http://www.arrhythmia.com/patient/other/HCM.html
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.
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.











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