When is a ventricle to thick

Question

About 5 years ago my husband was diagnoised with HCM (hypertrophic cardiomyopathy). He is a truck driver and for him to keep his license the LV must be below 30mm...He has chest pains alot with any physical exertion, and he lately he keeps saying he is dizzy. The doctors act like it no big deal. We had echo done last week and it should that the thickness went from 23mm to 40 mm. We are not sure what to do? where to go?

grendslori · Accepted Answer

HCM is a disease that I know very well; my daughter had a serious form of this disease and had to have a transplant. This is a disease of the heart muscle. "Cardio" refers to the heart and "Myopathy" literally, by definition, means: 'any disease of a muscle'. Put the two of them together and you have a muscle disease of the heart. It doesn't just affect the left ventricle, it can also affect the right ventricle as well. The reason your husband is having chest pain is because the wall thickness in some areas have outstripped the bloodflow to that area of the heart muscle; he may have completely clear arteries. The arteries are not where the problems are. Sudden death is an issue with this disease, however, the percentages are very low, about 2%. He should have a Holter Monitor placed for 72 hours to catch any arrhythmias if possible. An EP Study should be done as well to check the electrical system of his heart. Usually Calcium Channel Blockers are given because they tends to work better at relaxing the heart muscle and allow the left ventricle to fill better. The walls of the HCM heart are thick and stiff with muscle that is chaotic in alignment. This is a serious form of heart disease and the doctors who are taking care of him have to understand the mechanics of this disease. The Cleveland Clinic and the Mayo Clinic are probably two of the top places in this country to see specialists who deal with this disease. HCM is almost always genetic in nature so any children he has, as well as his parents and siblings should be tested to rule this disease out. This is not a disease caused by a virus; that is DCM which is an opposite problem to HCM. Sometimes, as in the case of our family, the disease is sporadic; no one knows why it happens.

Mom2four85 · Answer

thank you =)  I'm looking for all the info I can get before my dr's appt.

kenkeith · Answer

QU0TE: "Can you link me or pm me where those normal values came from? on my echo it says: LVESD  36 (23 - 40) & LVEDD 44 (35-57)" 
____________________________________________

I am pleased to give you a reference....it is very good for other parameters as well:)
http://www.researchgate.net/group/internal_medicine_clinical_pharmacology/board/thread/14141_echocardiography-refvalues_updates_2009

There is computer software with an associated algorithm that determines whether or not the dimension parameters indicate HCM and or dilated LV.  The parameters include the relation with LV mass to be LV end-diastolic internal dimension plus septal thickness plus left posterior wall thickness.  You report doesn't include septum wall dimension!? I believe that should be part of the equation HCM.

Thanks for the question; hope this helps.  Take care.

Mom2four85 · Answer

Can you link me or pm me where those normal values came from? on my echo it says: LVESD  36 (23 - 40) & LVEDD 44 (35-57)

Are these not the same thing as you mentioned above? LV systolic 30 to 40mm & LV diastolic is 52 to 70 mm - any clue why my (normal) measurements they have listed would be different? I'm adding this to my long list for my doctor :P

What I find weird are the normal variables aren't always the same - take my 2d Echo - I've noticed other people with all kinds of measurements but mine only shows a small portion of what others have - they didn't even measure my septal wall; is that normally done in a 2d echo?

kenkeith · Answer

For clarification: The normal values for LV systolic 30 to 40mm.  LV diastolic is 52 to 70 mm.  The septum wall (separates the left side from right side (11-13 mm). With HCM the septum is often is enlarged as well.  . 

Problem: An increase in wall dimensions crowds out filling space, and usually the walls are stiff and that also can impede adequate filling.  The heart can also dilate (chamber size increase) caused by pressures and increased blood volume. Reduced cardiac output from a diminished supply of blood from lungs can cause shortness of breath, chest pains, etc. With HCM, the left ventricle is the only chamber effected.  With dilation, all chambers can increase in size and a chest X ray can usually reveal whether or not it is HCM or dilation of the chambers.

Treatment: In situations of either dilation or hypertrophy, heart failure can be treated with medications like beta blockers (to relax the heart), ACE inhibitors or the newer angiotensin receptor blockers (to decrease the pressure against which the heart has to pump), diuretics (to ease breathing and help decrease excess fluid in the lungs and body), and digoxin and other medications  which improve the heart’s pumping strength.  

I have been taking a beta blocker (coreg) and ACE inhibitor (lisinopril) for going on 7 years.  My heart at one time was enlarged and low cardiac output, but therapy has reduced heart size to normal and the heart is pumping normally.

I think your doctor has confused you. You should get a copy of your report, and don't entirely rely on the understanding you may or may not get from your doctor. Hope this helps and if you have any further questions you are welcome to respond.  Take care.

Mom2four85 · Answer

I'm confused...I thought HCM was a disease that affects the heart muscle, causing the muscle to enlarge, or "hypertrophy"? which is what it sounds like has happened with your husband.  Maybe I'm not understanding what is meant by the measurements or terms?  I get lost sometimes in all the medial lingo & dx's.

I only ask because that's one thing I was told to look at as a possible diagnosis (as well as ARVD; DCM).  I know mine was 36mm back in July 2009 and I was told I had Mild Concentric left ventricular hypertropy, non ischemic cardiomyopathy, mild valve problems, sob, cp, fainting, with other things.

Try the HCMA  website - 4hcm.org it's a great forum and has tons of info. Lisa that runs the site is great and has a wealth of information for members to get - there's a number you can call with questions and she will guide you to the next steps and help you =)

patterson6163 · Answer

and i am new to this site so i kept looking in my inbox for answer, i appreciate all of the information.... about the rapid growth when i first posted this my family dr was giving me the measurements thats where 40 mm come from but a couple of hours ago the cardio dr called and said that in 2008 it was 23 mm in 2009 it was 30 mm and last week was his last echo and now it is 74 mm his symptoms has gotten alot worse in the last 3 months his heartrate is 50 at rest so the beta blocker slows his heartrate down even more

patterson6163 · Answer

this is what we know... the dr at vanderbilt told us he has a heart disease called hypertrophic cardiomyopathy a couple of years ago the left ventricular septal thickness was measured at 23 mm hg last year it was at 30 mm I was just told a few hours ago that it is 74mm now and that it is very serious that he is in high risk for sudden death i am worried sick and dont know what to do

kenkeith · Answer

Of more interest is the rapid growth of 23mm to 40mm, but there has been no time frame mentioned. If the parameter is within the reference range, a high wall dimension within the range can be normal thickness for a given individual.

ed34 · Answer

taking the normal thickness, I was shocked that the muscle thickness can increase to that level.

kenkeith · Answer

Its wall thickness based on the dimension given....23mm to 40mm.:)

ed34 · Answer

It does read as wall thickness to me.

erijon · Answer

Perhaps I misread your post, are you saying the wall of his LV is thickened or the LV itself has enlarged? These are two separate conditions.

Let us know.

Jon

kenkeith · Answer

HCM is not a disease, it is a sign for a disease involving the heart, and include increases in the afterload (high resistance the heart pumps against measured by blood pressure), and some primary diseases of the muscle of the heart.  Also, aortic stenosis (narrow of the valve opening), aortic regurgitation (back flow of blood due to valve opening enlargement, calcification of leaflets that don't close the valve effectively).

Then there can be heart muscle disease.  That problem can arise from a viral infection, alcohol, drugs, medication, etc.  Left Ventricular Internal Dimension (systole); normal range 21 - 40 mm.  The report is an estimate of LV dimension and the given size is 40 mm and certainly within the margin of error.

To provide a better assessment of your husband's status of the LV size would require knowing the underlying problem. Your doctor should provide information on the underlying problem, if there is any problem. Also, the doctor should be able to explain the chest pain, etc.  Pain with exertion can be due to occluded heart vessels, and occluded vessels can cause HCM.  Tresatment would be medication and/or stent implant. 

With the information provided that is about all one can say regarding current health condition.  If you have any further information, you are welcome to respond.  Sorry to hear of the problem, but the doctors should be more forthcoming.  Take care.