should I be concerned?

I recently was diagnosed, via nuclear stress test with Hypertrophic Cardiomyopathy. My doctor has scheduled an echo for 3 weeks away. I am beginning to wonder if I should be worried. He can not hear a murmur, so feels it is not urgent. female, 53, slightly hi chol. chest tightness, feel pressure, can't lay down to sleep, pain in middle of chest up high. What else should I be doing? Oh, yes, on weight loss diet. I brought friends' 4 mo. old boy in, to CCF who is awaiting new heart-right now. So, this has me quite nervous. Thanks

[CCF-M.D.-CRC]

Dear mtnest,
A nuclear stress test is not considered the "gold standard" for making the diagnosis of hypertrophic cardiomyopathy so I would wait until the echo results are back before jumping to any conclusions.  I am surprised that it is a 3 week wait for an echo.  Perhaps they could move it up a little bit to put your mind at ease.  If there is thickening of the walls of the heart then the cause must be determined.

The most common cause of heart thickening is high blood pressure.  Other causes such as athletic heart, infiltrative diseases and hypertrophic cardiomyopathy are less common. 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.


Additional web sites with information about HOCM are listed below.

http://www.americanheart.org/Heart_and_Stroke_A_Z_Guide/cmyopa.html

HOCM Support groups

http://www.kanter.com/hcm/

http://www3.bravenet.com/forum/show.asp?userid=qf175386

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