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The goal of treatment is to control symptoms and prevent complications. Some patients may need to stay in the hospital until the condition is under control (stabilized).

If you have symptoms, you may need medication to help the heart contract and relax correctly. Drugs include beta-blockers and calcium channel blockers. These medicines reduce chest pain and pain during exercise. Medications will often relieve symptoms so patients do not need more invasive treatments.

Some people with arrhythmias may need anti-arrhythmic medications. If the arrhythmia is due to atrial fibrillation, blood thinners will also be used to reduce the risk of blood clots.

Some patients may have a permanent pacemaker placed. However, pacemakers are used less often today than they were in the past.

When blood flow out of the heart is severely blocked, an operation called surgical myectomy is done. This procedure cuts and removes the thickened part of the heart. Patients who have this procedure often show significant improvement. If the heart’s mitral valve is leaking, surgery may be done to repair or replace the valve.

In some cases, patients may be given an injection of alcohol into the arteries that feed the thickened part of the heart (alcohol septal ablation).

Implantable cardioverter-defibrillator (ICD): This is a pager-sized device implanted in your chest like a pacemaker. An ICD continuously monitors your heartbeat. If a life-threatening arrhythmia occurs, the ICD delivers precisely calibrated electrical shocks to restore a normal heart rhythm. A small number of people with hypertrophic cardiomyopathy are at risk of sudden cardiac death because of abnormal heart rhythms. In these high-risk individuals, many doctors recommend the implantation of an ICD.

Pacemaker Implantation:A pacemaker is a small electronic device inserted under your skin that sends electrical signals to your heart to monitor and regulate your heartbeat. Surgery to implant the pacemaker is usually performed under local anesthesia and typically takes less than three hours. Pacemaker implantation is generally not as effective as surgical options, but it’s sometimes used in older people who want to avoid more invasive procedures.

Septal Ablation:Also called septal alcohol ablation, this is a new treatment in which a small portion of the thickened heart muscle is destroyed by injecting alcohol through a catheter into the artery supplying blood to it. There are possible complications with this procedure, including heart block a disruption of the heart’s electrical system which requires implantation of a pacemaker. The long-term success of this procedure isn’t yet known, but it’s becoming more commonly used.

Septal myectomy:This is an open-heart operation in which the surgeon removes part of the thickened, overgrown heart muscle wall (septum) that separates the two bottom heart chambers (ventricles). Removing part of this overgrown muscle improves blood flow and reduces mitral regurgitation. Myectomy is used if medications don’t relieve symptoms. Most people who have symptoms and undergo myectomy have no further symptoms. This type of surgery is only available in medical centers that specialize in the treatment of hypertrophic cardiomyopathy.

Drug Treatment:This is the best option for most people. Various medications can help relax the muscle and slow the rate so that the heart can pump more efficiently. Some of the drugs your doctor may suggest include beta blockers, calcium channel blockers or the anti-arrhythmic medications disopyramide or amiodarone.

Amiodarone:This is a powerful antiarrhythmic medicine that sometimes is used to treat people with hypertrophic cardiomyopathy who have ventricular tachycardia or atrial fibrillation (two types of rapid heartbeat) or who are at high risk of sudden death. Research on amiodarone continues, but so far the drug has not been shown conclusively to prevent sudden death. In addition, long-term use of amiodarone may cause serious side effects in some people.

Disopyramide:The antiarrhythmic medicine disopyramide (Norpace) is sometimes used, especially if you have fainting or near-fainting episodes. This medicine can decrease the force with which the heart contracts and reduce the number of abnormal heart rhythms. It helps limit symptoms of heart failure.

Calcium Channel Blockers:If you do not improve after taking beta-blockers, your doctor will probably try a calcium channel blocker, such as verapamil (Calan or Verelan, for example). These medicines also slow heart rate and lower blood pressure. Conversely, your doctor may first try a calcium channel blocker and switch to a beta-blocker if you don’t get results. These medicines usually are not given at the same time.

Beta-Blockers:Beta-blockers, such as propranolol (Inderal, for example) or atenolol (Tenormin), are often used to treat people who develop symptoms such as shortness of breath or chest pain. They lower blood pressure, slow heart rate, and improve blood flow, which helps decrease symptoms and improves your ability to exercise. They may even prevent or delay the progression of heart failure related to hypertrophic cardiomyopathy.

Atrial fibrillation occurs in about one in four people with hypertrophic cardiomyopathy. In atrial fibrillation, abnormal electrical impulses cause the upper chambers of the heart (atria) to fibrillate, or quiver, resulting in irregular and rapid beating of the ventricles, the heart’s main pump. For most people, this aspect of atrial fibrillation in itself is usually not life-threatening. However, for people who have hypertrophic cardiomyopathy, atrial fibrillation can increase your risk for other abnormal heart rhythms that can be life-threatening. It also increases your risk for heart failure and stroke. For these reasons, most doctors aggressively treat atrial fibrillation in people who have hypertrophic cardiomyopathy. Aggressive treatment may include medicines to control the heart rate or rhythm, electrical cardioversion to return the heart to its normal rhythm, or catheter ablation or surgery to destroy heart tissue that is causing atrial fibrillation. For more information, see the topic Atrial Fibrillation.

Anticoagulants often are prescribed for people who have atrial fibrillation. Anticoagulants help protect against blood clots that develop in the heart. Blood clots can be dangerous because they may break loose and travel through the bloodstream (thromboembolism), which may cause a stroke, heart attack, or blocked blood flow to an arm or leg.