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Causes of cardiomyopathy

  Dear Sirs;
  I have been diagnosed as having non-obstructive hypertrophic cardiomyopathy. From the information I have been able to get off the internet, hypertrophic cardiomyopathy appears to be an unusual disease in which the ventricular muscle hypertrophies with no good reason.  I am wondering, could my problem have been caused by a severe blow to the front of my chest on the upper left side which I sustained approximately a year ago.  I had a broken scapula and bruising, torn tendons etc. as a result of a motorcycle accident.  I am and have been physically active but am not a professional athelete.  At the time of the accident an xray was taken and the report on that xray said "the size and shape of the heart appear to be normal".  Can an xray disclose the presence of hypertrophic cardiomyopathy?  I understand that steriods can sometimes cause a thickening of the heart muscle.  I have been taking a topical cortisone cream for the treatment of psoriasis for over twenty years.  Could this have anything to do with my poblem?  Have you ever heard of my problem being caused by any of the things to which I have referred?  I have two brothers, both younger, who do not have hypertrophic cardiomyopathy.  I myself, have never had any problems until after my accident.  I thank you for your consideration and eagerlly await your response.
Dear  Greg,
Topic Area: Cardiomyopathy
Hypertrophic cardiomyopathy is a congenital condition that occurs from the time of birth.  Trauma or steroids would not precipitate this condition.  The condition will not appear on xray and is diagnosed with echocardiogram.   I have placed some general information on this condition below.
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.
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.

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