When the heart muscles are abnormally thick, it makes it very difficult for the heart to pump blood. This condition that causes thickening of the heart muscles, is called hypertrophic cardiomyopathy (HCM). Many times, this condition goes unnoticed because a few handful people develop few or no symptoms related to this condition. However, this condition can lead to death due to sudden cardiac arrest, especially in young athletes.
One of the main causes is gene mutation. The mutation causes the heart muscles to grow thick and in some cases develop an abnormal heart muscle fiber arrangement. This causes the heart muscles to get intertwined and lead to a condition called myofiber disarray. This is a 'autosomal dominant' disorder that requires just a single abnormal gene from the parent to be passed on to the child.
Once the gene is passed on, there are 50% chances the child may exhibit the symptoms of this disease. It has also been found, in more than half the cases of hypertrophic cardiomyopathy, this is not an inherited conditions. Instead, it is a spontaneous mutation that leads to development of this disease in the child. Hypertrophy may occur as an acquired condition in the aged due to high blood pressure and natural aging process.
This complex heart disease affects the heart muscles and leads to a number of heart problems. These heart problems affect the functioning of the heart. Some of the complications due to thickening of the heart muscles are as follows:
Diastolic dysfunction: The walls of the ventricles become thick and thus, the amount of blood filled in the ventricles reduces. When this happens, the blood tends to accumulate in the lungs. This causes the patient to suffer from shortness of breath with little exertion.
Systolic dysfunction: The pumping action of the heart is abnormal, causing insufficient amount of blood to be pumped out of the heart. This happens due to the abnormal functioning of the mitral or aortic valve. These valves are distorted due the abnormal thickening of the cardiac muscles in the ventricles.
Dilated cardiomyopathy: One of the main causes of heart failure is dilated cardiomyopathy. This condition occurs due to the overexertion of the thickened heart muscle.
Sudden Death:Ventricular tachycardia or ventricular fibrillation leads to sudden death of the patient. This occurs due to vigorous exertion especially in athletes. It may even occur after minimal exertion in teenagers as people in their early 20s without warning whatsoever.
Symptoms become apparent when a young person suddenly collapses and dies. This happens due to presence of arrhythmias or a blockage of the heart vessels. In many patients, this condition causes no symptoms and the condition is uncovered during a routine examination.
Some of the possible symptoms of thickening of the heart include:
- Chest pain
- Fainting spell, especially after a strenuous exercise
- High blood pressure
- Lightheadedness after exerting activity
- Heart palpitations
- Shortness of breath (even when lying down)
Hypertrophy cardiomyopathy is often diagnosed due to the presence of a heart murmur heard by the doctor when listening to the heart. The abnormal blood flow through the heart causes the murmur. Apart from the murmur, the doctor may advise an echocardiogram, electrocardiogram, cardiac catherterization and cardiac MRI in severe cases.
There is no specific treatment available as the changes cannot be reversed. However, the treatment available helps in reducing the symptoms and preventing any complications. Patients who do not show any symptoms or have very mild symptoms, generally do not require any kind of treatment. Treatment for hypertrophic cardiomyopathy includes medications like beta-blockers, antiarrhythmic drugs and warfarin.
Some patients may be suggested septal myectomy, a surgical procedure that removes the thickened heart muscle wall present between the two ventricles. This helps in reducing mitral regurgitation. This surgical procedure is used only when the medications don't seem to help.
Other treatments include septal ablation, pacemaker implantation and implantable cardioverter-defibrillator (ICD). The doctor will advise patients with hypertrophy cardiomyopathy to reduce their physical activity, change their diet and manage their weight. Smoking should be avoided completely and drinking alcohol should also be controlled.
Thickening of the heart muscles is one of the main reasons for sudden cardiac death. Thus, people with this condition should take extra precautions about their overall health and avoid any kind of strenuous activity that puts pressure on their heart muscles. Apart from this, make sure you follow your doctors advise by the book to avoid any complications due to this disease of the myocardium.