Treatment for hypertrophic cardiomyopathy (HCM) aims to
- improve symptoms and quality of life,
- prevent sudden cardiac death, and
- due to the genetic nature of the disease, inform all families members about HCM.
Reducing the obstruction to blood flow from the heart’s left ventricle has emerged as an important way to improve overall heart function, which reduces the frequency and severity of symptoms. Importantly, while reducing the obstruction typically improves symptoms, it does not necessarily decrease the risks of a sudden cardiac event, although this is an area physician-scientists are actively researching.
If you are diagnosed with HCM, it is always best to explore all possible treatment options. While medications are still the first and most common treatment option, and they can improve symptoms in up to half of HCM patients, other treatments might also be effective and recommended for your symptoms and condition. This is especially important if medications are not providing enough relief. Two additional treatment options that are currently recommended by soon-to-be-available national clinical guidelines are septal myectomy and alcohol septal ablation.
Septal Myectomy for Hypertrophic Cardiomyopathy
Septal myectomy is an open-heart procedure that removes part of the thickened septal wall that is blocking blood flow from the left ventricle to the aorta. This is one treatment option that is available for patients with progressive heart failure despite medical therapy and is usually the first consideration for the majority of eligible patients. This option is available to patients who are strong and healthy enough to undergo surgery, and it is also recommended for those with additional abnormalities of the heart that need mechanical correction. There are certain cases when septal myectomy is always the preferred treatment method; however, considerations for favoring this procedure include
- greater septal thickness (greater than 3.0 cm) or other cardiac disease that requires additional surgical correction.
The procedure takes approximately three to four hours and usually requires a five- to six-day hospital stay plus additional outpatient rehabilitation. Septal myectomy has been established as an effective and proven approach with a high success rate for reversing the consequences of heart failure, when it is performed in high-volume surgical centers with significant experience in this particular surgery.
Surgeons are required to have special training prior to performing septal myectomy (greater than 20 surgeries without the need for valve replacement). So, if you are considering septal myectomy, work with your physician to find a qualified medical center and an experienced doctor to perform the procedure.
Alcohol Septal Ablation for Hypertrophic Cardiomyopathy
Alcohol septal ablation is a minimally invasive procedure recommended for patients who are not ideal candidates for surgery, or for patients who -- after they understand the risks and benefits of both treatment options -- strongly prefer to avoid surgery if at all possible.
Alcohol septal ablation offers similar symptom relief as septal myectomy but is much less invasive. During the procedure, a very small amount of alcohol is injected directly into the protruding heart wall using your heart’s own arteries. This causes that small part of the muscle to die and eventually shrink, which allows blood to flow more freely out of the heart.
The procedure takes about one to two hours and is done using a thin, flexible catheter that is threaded through the blood vessel and to the heart, similar to how angioplasty is performed in patients who have blockages in their heart’s arteries. During alcohol septal ablation, the patient remains awake and may feel some discomfort when the alcohol is injected. If this is the case, pain medication or sedatives are given to help the patient relax.
One of the most common side effects of alcohol septal ablation is called a “complete heart block,” meaning the impulse from the upper atrial chambers of the heart is not transmitted to the lower ventricle chambers. If this occurs, a permanent pacemaker will be implanted. While the need for a pacemaker may also occur after septal myectomy, the risk of needing one is higher (roughly 5 to 10 percent) after alcohol septal ablation.
Physicians are required to have special training prior to performing the procedure (more than 20 procedures recommended). So, if you are considering alcohol septal ablation, work with your physician to find a qualified medical center and an experienced doctor to perform the procedure.
Additional treatment options that your doctor may discuss with you include:
- Medications, such as beta blockers to calm any excessive “adrenaline surges,” reduce the resting heart rate, improve obstruction, and help to prevent the development of arrhythmias (problems with the heart’s rhythm). Sometimes more powerful antiarrhythmic medications need to be used, or combinations of medications.
- Implantable Cardiac Defibrillator (ICD) Placement: ICDs are implanted in a patient’s body to monitor for abnormal and dangerous heart rhythms. If a dangerous heart rhythm develops, the ICD will deliver a shock to the patient’s heart to return it to a normal beat
Questions to Ask Your Doctor About Treatments for Hypertrophic Cardiomyopathy.
Before undergoing septal myectomy, alcohol septal ablation, or any other procedure, it is important to speak with your doctor to ensure you fully understand the procedure and discuss any questions or concerns you may have. A few questions to ask your doctor may include:
- What are the risks and/or benefits of each procedure?
- Is it possible to get a consultation from both a surgeon and an interventional cardiologist first?
- Which procedure is ideal for my individual situation?
- How do I know if a physician and/or medical center is qualified to perform alcohol septal ablation?
- What do I need to do prior to my procedure to prepare?
- What can I expect following the procedure?
- What everyday activities should I avoid following the procedure?
- When will I be able to resume my normal lifestyle and return to work?
Prevention of Hypertrophic Cardiomyopathy
Unfortunately, hypertrophic cardiomyopathy is inherited and cannot be prevented, but early detection is key in avoiding further complications and facilitating treatment. Intense exercise and competitive sports should be avoided. Some patients can participate in low-intensity sports and exercise, but it is best to speak with your cardiologist beforehand for recommendations.
Sudden cardiac death, however, can be prevented in those patients who already have an implantable cardioverter-defibrillator (ICD).
Practicing overall heart-healthy habits may also help, and may be particularly useful when undergoing treatment. Here are several tips to help you achieve this:
Based on your unique medical history, risk factors, symptoms, and lifestyle, your doctor will work with you to determine the best treatment option for you.
You can print this list of questions to take to your doctor here. (PDF)