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The clinical course of HCM is variable. Many patients are asymptomatic or mildly symptomatic. The symptoms of HCM include dyspnea (shortness of breath), chest pain (sometimes known as angina), uncomfortable awareness of the heart beat (palpitations), lightheadedness, fatigue, fainting (called syncope) and sudden cardiac death. Dyspnea is largely due to increased stiffness of the left ventricle, which impairs filling of the ventricles and leads to elevated pressure in the left ventricle and left atrium. Symptoms are not closely related to the presence or severity of an outflow tract gradient. Often, symptoms mimic those of congestive heart failure , but it must be noted that treatment is very different. To treat with diuretics (a mainstay of CHF treatment) will exacerbate symptoms in hypertrophic cardiomyopathy by decreasing ventricular volume and increasing outflow resistance.

Risk factors for sudden death in individuals with HCM include a young age at first diagnosis (age < 30 years), an episode of aborted sudden death, a family history of HCM with sudden death of relatives, specific mutations in the genes encoding for troponin T and myosin, sustained supraventricular or ventricular tachycardia, ventricular septal wall thickness over 3 cm, hypotensive response to exercise, recurrent syncope (especially in children), and bradyarrhythmias (slow rhythms of the heart).

Hypertrophic Cardiomyopathy Signs and Symptoms

1.Shortness of breath
2.Sensation of feeling the heart beat (palpitationspalpitations)
3.Light-headedness, especially with or after activity or exercise
4.High blood pressure (hypertension)
5.Heart failure (in some patients)
6.Fainting, especially during exercise
7.Dizziness
8.Chest pain
9.Shortness of breath when lying down
10.FatigueFatigue, reduced activity tolerance

Some patients have no symptoms. They may not even realize they have the condition until it is found during a routine medical exam.

The first symptom of hypertrophic cardiomyopathy among many young patients is sudden collapse and possible death. This is caused by very abnormal heart rhythms (arrhythmiasarrhythmias), or from the blockage of blood leaving the heart to the rest of the body.

Hypertrophic cardiomyopathy is a major cause of death in young athletes who seem completely healthy but die during heavy exercise. However, certain normal changes in athletes’ hearts can confuse the diagnosis.

Sudden death may occur from the onset of ventricular tachycardia (a type of rapid heart rate) or other dangerous arrhythmias. A genetic factor appears to influence which people with hypertrophic cardiomyopathy are more prone to sudden death. Other risk factors for sudden death include severe obstruction of the left ventricle, multiple fainting (syncope) episodes, recurring episodes of ventricular tachycardia, and an abnormal drop in blood pressure during exercise.

Although it can occur in any age group, sudden death is most shocking when it happens to young adults or athletes. While these tragic deaths are often given prominence in the media, sudden death is rare (1% or less per year in adults with hypertrophic cardiomyopathy).1
Complications of hypertrophic cardiomyopathy

Atrial fibrillation is a common complication of hypertrophic cardiomyopathy. This abnormal heart rhythm interferes with the normal pumping of the heart. It can cause blood clots to develop in the heart, which can break off and travel through the bloodstream (systemic embolism). This may cause a stroke, heart attack, or blocked blood flow to an arm or leg.

Heart failure may develop if the disease progresses. In heart failure, the heart’s lower chambers are not able to pump blood effectively enough to meet the body’s needs for oxygen and nutrients. Common symptoms include fluid buildup (edema) in the legs, ankles, and feet; shortness of breath while lying down or exercising; and increased urination at night.
Athlete’s heart syndrome

People who exercise regularly and vigorously often develop changes in their heart muscle that can be confused for hypertrophic cardiomyopathy. In such athletes, the heart muscle grows to adapt to the extra demands from physical activities. This condition is called athlete’s heart syndrome. But unlike hypertrophic cardiomyopathy, athlete’s heart syndrome does not cause life-threatening heart rhythms and sudden death. It is a benign, or harmless, condition. When an athlete stops training, the heart returns to a normal size unlike those with hypertrophic cardiomyopathy, in which the heart remains enlarged.