Treatment Planning
Shared decision-making guides your HCM treatment plan
Partnering with your health care team is the key to developing a treatment plan that will enable you to live an active and enjoyable life while managing hypertrophic cardiomyopathy (HCM). Your treatment plan will address your HCM diagnosis as well as any conditions that contribute to it. The goal is to reduce symptoms, complications and the risk of sudden cardiac arrest (SCA).
Your doctor will begin by asking you about your lifestyle. It is important for you to be honest during this discussion because doctors generally classify patients’ heart failure according to the severity of their self- reported symptoms. You are the only source of answers for these important questions:
- Employment: What type of work do you do? Is it physical? If so, do you hope to continue in that same capacity?
- Exercise: What physical activities do you enjoy? How often do you exercise? Do you have any breathing difficulties or chest pain while you exercise?
- Lifestyle: Do you use alcohol and/or tobacco products? How often?
- Medications: Do you take medication to control your cholesterol?
- Nutrition: Do you generally follow a healthy diet?
To classify your heart condition based on symptoms and limitations experienced during physical activity, including breathing difficulties and chest pain, your doctor will then consult the New York Heart Association (NYHA) Functional Classification System. This system uses four categories. In addition to influencing treatment decisions, the results are often an indicator of prognosis.
| Class Type | Description | ||
| Class I | No limitation of physical activity. Ordinary physical activity does not cause symptoms of heart failure. | ||
| Class II | Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in symptoms of heart failure. | ||
| Class III | Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes symptoms of heart failure. | ||
| Class IV | Symptoms occur even at rest; discomfort with any physical activity. Unable to carry on any physical activity without symptoms of heart failure. | ||
Treatment Options
Your treatment may include one or more strategies. Keep in mind that the strategy may change as your condition changes. Follow-up appointments and keeping the lines of communication open with your health care team will help you stay alert to any indications that a change in treatment is necessary.
Medication is generally the first line of treatment to help relieve and control HCM symptoms. Ensure your doctor and your pharmacist are aware of any medications (over-the-counter and prescription) you currently take for other conditions. It is possible those medications may interact with new ones and could pose an additional risk to you.
Before beginning a new HCM medication, ask about potential side effects and what to do if a side effect occurs. You will feel more confident when you have a plan in place.
Many HCM medications are oral (pills). Because you are responsible for taking them as opposed to going to your doctor’s office for a treatment, it is important that you are educated about medication adherence. For them to be fully effective, you must take them exactly as your doctor instructs. Most therapies are designed to maintain a specific level of drugs in your system for a certain time based on your condition, your overall health, previous therapies and other factors. If your medications are not taken exactly as prescribed, the consequences can be serious — even life-threatening.
Depending on the number of medications you take daily, staying on schedule can be confusing. You are encouraged to use tools that can help. Make a daily medication schedule that allows you to note the time, the dosage and any side effects that you experience. Sharing these details allows your doctor to manage and monitor these side effects. Download a free symptom tracker at Heart.PatientResource.com/HCMSymptomTracker. These suggestions may also help.
- Talk with your pharmacist. Pharmacists are an underused resource, but they are skilled in counseling patients on the safe and appropriate use and storage of their medications. Your pharmacist is an excellent source for helping you understand new medications and potential interactions, especially if you already have multiple prescriptions for other conditions.
- Report missed doses. Alert your doctor about any changes in the schedule. If you miss a dose, tell your health care team so they can advise you whether to take a dose immediately or wait until your next scheduled dose. Do not make changes to your treatment regimen without being told to do so by your doctor.
- Use reminders. Life gets busy, and it is easy to forget to take your medications. You have many options: alarms, phone reminders, a weekly pillbox, calendars, sticky notes or smartphone apps.
Surgery is often recommended when medication does not offer enough relief. Depending on your unique situation, your doctor may recommend one or more of the following procedures.
Maze is a type of open-heart surgery designed to treat atrial fibrillation (AFIB). It creates scar tissue that traps the electrical signals that cause AFIB. It is most commonly performed when another open-heart procedure is taking place.
Mitral valve repair or replacement can be performed to repair a faulty mitral valve or replace it with a mechanical or biological tissue valve.
Septal myectomy is a type of open-heart surgery designed to reduce muscle thickening. It is generally reserved for younger patients. During this procedure, the surgeon removes part of the thickened septum to improve blood flow within the heart and out to the body.
An implantable device may be part of your treatment plan and may include one of the following:
- A cardiac resynchronization therapy (CRT) device coordinates contractions between the left and right ventricles of the heart.
- An implantable cardioverter defibrillator (ICD) is a small electronic device that helps maintain a normal heartbeat by sending an electric shock to the heart if an irregular heartbeat is detected. This reduces the risk of sudden cardiac death (SCD). This device is inserted under the skin like a pace- maker and is designed to deliver a small shock to the heart in the event that you suffer a life-threatening heart rhythm problem.
- A pacemaker is a small, implanted device that uses electrical pulses to prompt the heart to beat at a normal rate.
Heart transplant replaces a person’s diseased heart with a healthy donor heart. It may be considered at end-stage disease.
Non-surgical procedures include types of ablation. Ablation is the removal or destruction of a body part or tissue or its function. It typically offers an easier recovery than a surgical procedure and may reduce or help control symptoms. Your doctor may choose one of the following:
Alcohol septal ablation is a percutaneous (through the skin) procedure that involves injecting alcohol into a blood vessel in the ventricular septum. This causes some of the heart muscle cells to die, making the septum thinner.
Catheter ablation to treat arrhythmias involves accessing the heart using a catheter (a thin, flexible tube) to destroy tissue around the heart to block arrhythmia-causing electrical signals. This procedure may be performed by radiofrequency ablation using low voltage, high frequency electricity or by cryoablation, which uses extreme cold.
Pulmonary vein isolation (PVI) is designed to treat atrial fibrillation (AFIB) by creating scar tissue that limits or blocks the abnormal signals that cause AFIB.
Clinical trials may be an option to discuss with your doctor about your treatment plan or for a family member to consider. Clinical trials are research studies that test a new medical approach, including new drugs, drug combinations, medical procedures or devices that help diagnose and treat HCM. They also explore methods to improve patient screening, new diagnostic tools, ways to prevent and manage side effects, and lifestyle changes that may improve the health of a person who has HCM.
By participating, you are contributing to how HCM is diagnosed, treated and hopefully, one day, cured. Recent studies have shown that the quality of research increases when the volunteers come from diverse groups because different life experiences add valuable perspectives to these projects.
The ultimate goal is to help anyone facing HCM enjoy longer, more fulfilling lives. Ask your doctor whether a clinical trial may fit into your treatment plan.
| Type of Medication | Goal | ||
| Antiarrhythmics | Help the heart beat normally by blocking irregular electrical activity and rhythms caused by the thickening of the heart’s walls. | ||
| Beta blockers | Reduce the heart rate and reduce blood pressure by dilating blood vessels. They can also prevent further heart attacks and death after a heart attack. | ||
| Blood thinners (anticoagulants) | Prevent the formation of blood clots. | ||
| Calcium channel blockers (CCBs) | Lower blood pressure and slow the heart rate. CCBs dilate the arteries, reducing pressure within the heart and making it easier for it to pump blood. As a result, the heart needs less oxygen. | ||
| Cardiac myosin inhibitor* | Improves functional capacity and symptoms of NYHA Class II-III symptomatic obstructive HCM by helping the heart beat less forcefully. | ||
| Cholesterol-lowering medications | Designed to regulate cholesterol and can complement the dietary changes that are recommended. | ||
| Corticosteroids | Reduce inflammation. | ||
| Diuretics | Remove excess fluid and sodium from the body. | ||
| Sodium channel blockers | Inhibit the movement of sodium into cells; may be used with beta blockers to reduce symptoms. | ||
