Hypertrophic Cardiomyopathy: Symptoms, Risks, and Diagnosis

Hypertrophic cardiomyopathy

Dear Dr.
He,
About five or six years ago, I began experiencing chest tightness during exercise.
When the symptoms are severe, I also have shoulder and back pain, cold sweats, low blood pressure, dizziness, pale complexion, and overall fatigue (lasting approximately 10 to 20 minutes), and I must lie down to alleviate the discomfort.
It wasn't until last year that an abnormal electrocardiogram led to an echocardiogram, which confirmed hypertrophic cardiomyopathy.
My blood pressure is usually normal.
At the end of last year, I also fainted and was taken to the emergency room, where several cardiac enzymes were tested, and one of them, troponin, was elevated.
I would like to ask if the elevated troponin level is related to hypertrophic cardiomyopathy and whether it indicates any serious issues.
Additionally, what is the difference between obstructive and non-obstructive symptoms? I have seen two doctors; one said I have non-obstructive hypertrophic cardiomyopathy, while the other believes I have obstructive hypertrophic cardiomyopathy.
Thank you.

S, 20~29 year old female. Ask Date: 2010/03/28

Dr. He Dongjin reply Cardiology

I am not sure where you had the examination for non-obstructive versus obstructive conditions.
The difference lies in whether there is a blockage in the left ventricular outflow tract.
A significant pressure gradient indicates the possibility of obstruction, which could lead to sudden cardiac death.
Non-obstructive cases may be managed with medication or simply monitored.
Elevated troponin levels should be associated with hypertrophic cardiomyopathy.
It is advisable to undergo a thorough examination and treatment at a medical center.
Changhua Hospital cares about your health.

Reply Date: 2010/03/28

More Info

Hypertrophic Cardiomyopathy (HCM) is a genetic condition characterized by the thickening of the heart muscle, particularly affecting the left ventricle. This thickening can lead to various symptoms and complications, making it essential to understand its implications, risks, and diagnostic methods.

Symptoms of Hypertrophic Cardiomyopathy
Patients with HCM may experience a range of symptoms, which can vary in severity. Common symptoms include:
1. Chest Pain: Often occurring during physical exertion, as you described experiencing chest tightness during exercise.

2. Shortness of Breath: This may occur during exertion or even at rest in more severe cases.

3. Palpitations: Irregular heartbeats or a sensation of a racing heart.

4. Dizziness or Lightheadedness: This can happen due to reduced blood flow, especially during exertion.

5. Fainting (Syncope): As you mentioned, fainting episodes can occur, particularly during physical activity.

6. Fatigue: General tiredness or lack of energy, which can be debilitating.

Risks Associated with Hypertrophic Cardiomyopathy
HCM can lead to several serious complications, including:
1. Sudden Cardiac Death: This is a significant risk, especially in younger athletes. The risk is higher in those with a family history of sudden cardiac death due to HCM.

2. Heart Failure: Over time, the thickened heart muscle can lead to diastolic dysfunction, where the heart struggles to fill properly, leading to heart failure symptoms.

3. Atrial Fibrillation: This irregular heartbeat can increase the risk of stroke.

4. Obstructive HCM: In some patients, the thickened muscle can obstruct blood flow out of the heart, leading to more severe symptoms and complications.

Diagnosis of Hypertrophic Cardiomyopathy
Diagnosis typically involves several steps:
1. Medical History and Physical Examination: A thorough history, including family history of heart disease, is crucial.

2. Electrocardiogram (ECG): This test can reveal abnormal heart rhythms and signs of left ventricular hypertrophy.

3. Echocardiogram: This ultrasound of the heart is the gold standard for diagnosing HCM. It can visualize the thickened heart muscle and assess its function.

4. Cardiac MRI: This imaging technique can provide detailed images of the heart and help assess the extent of hypertrophy.

5. Genetic Testing: Since HCM is often hereditary, genetic testing may be recommended for you and your family members.

Troponin Levels and Their Significance
Troponin is a protein released when the heart muscle is damaged. Elevated troponin levels can indicate myocardial injury, which may occur in various conditions, including HCM. In your case, the elevated troponin levels during your emergency visit could suggest that there was some degree of myocardial stress or damage, possibly related to your HCM. It is essential to discuss these results with your cardiologist, as they can provide insights into the implications of elevated troponin in the context of your HCM.

Obstructive vs. Non-Obstructive HCM
The distinction between obstructive and non-obstructive HCM is crucial:
- Obstructive HCM: In this form, the thickened heart muscle obstructs blood flow from the left ventricle to the aorta, often leading to more severe symptoms and requiring specific treatments, such as medications or surgical interventions.

- Non-Obstructive HCM: Here, the thickening does not significantly obstruct blood flow. While patients can still experience symptoms, the management may differ, often focusing on lifestyle changes and monitoring.

Conclusion
Given your symptoms and the diagnosis of HCM, it is vital to maintain regular follow-ups with your cardiologist. They can help monitor your condition, manage symptoms, and reduce the risk of complications. Lifestyle modifications, such as avoiding intense physical exertion, may also be recommended. If you have any concerns about your symptoms or treatment options, do not hesitate to reach out to your healthcare provider for personalized advice and management strategies.

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