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Heart Disease (Expert Forum)
pacer for HOCM
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pacer for HOCM
by baseballfan, Oct 10, 2002 12:00AM
After being diagnosed with hypertrophic obstructive cardiomyopathy 2 1/2 years ago, I have tried large doses of Atenolol (100 mg), Norpace (600 mg), and Cardizem (240 mg) per day. My resting gradient has decreased but my provocable gradient (with Dobutamine echo) was still over 200. My septal size is not that great (1.6 to 2.0).Before meds, I had chest pain with very minimal exertion. However, on meds my chest pain is greatly reduced but I am terribly SOB and dizzy at times with exertion, becoming overheated, etc. One month ago, I had an EPS done and ended up with a pacer/ICD. Since the surgery, my SOB has increased to the point that I cannot do the menial task or walk short distances without panting for breath. Can you provide any explanation for this? I was hoping to feel better, not worse.I should mention that during the implantation, my EP said my gradient fell to 25 and so he was encouraged but I now understand that the gradient does not always stay that low and also I have heard that sometimes with this procedure, mitral regurg increases. I have tried to avoid more invasive procedures like alcohol ablation or myectomy and don't know if I would even qualify with the septal measurement that I have. What do you think is going on here? I have 3 children and its hard to keep up with them feeling like I do. Thanks for any insight you can provide.
Doctor's Answer
by CCF-M.D.-KE, Oct 10, 2002 12:00AM
Dear baseballfan,
Pacemakers for HOCM evolved from the theory that RV contraction following atrial contraction would reduce the LVOT gradient. Two studies looked at pacemakers in people with HOCM, the PIC study and the M-PATHY study. The studies did seem to show that pacing decreased the gradient and 1 study showed an improvement in symptoms while the other did not. Unfortunately for you it does not sound as if pacing has helped with your symptoms.
This is an area where there is not a lot of research to guide our therapy. I would recommend seeing a specialist in this area such as those here at the Cleveland Clinic. Dr. Harry Lever specializes in HOCM and would be an excellent doctor to see. I would suggest an appointment with him to discuss further options such as the invasive options you have mentioned.
Call 1-800-CCF-CARE
Thanks for your question,
CCF-MD-KE
Pacemakers for HOCM evolved from the theory that RV contraction following atrial contraction would reduce the LVOT gradient. Two studies looked at pacemakers in people with HOCM, the PIC study and the M-PATHY study. The studies did seem to show that pacing decreased the gradient and 1 study showed an improvement in symptoms while the other did not. Unfortunately for you it does not sound as if pacing has helped with your symptoms.
This is an area where there is not a lot of research to guide our therapy. I would recommend seeing a specialist in this area such as those here at the Cleveland Clinic. Dr. Harry Lever specializes in HOCM and would be an excellent doctor to see. I would suggest an appointment with him to discuss further options such as the invasive options you have mentioned.
Call 1-800-CCF-CARE
Thanks for your question,
CCF-MD-KE
