Hypertrophic cardiomyopathy, or HCM, is a form of
cardiomyopathy. This is a condition in which the heart muscle thickens due to genetic problems with the muscle’s structure. As the muscle thickens, it must work harder to pump blood, which strains the heart muscle. Sometimes, the thickened muscle gets in the way of the blood leaving the heart and causes a blockage. This blockage can cause the neighboring heart valve, called the mitral valve, to become leaky. HCM can cause uneven muscle growth which can cause the heart to pump in a disorganized way. Rarely, it can cause abnormal heart rhythms that can even be fatal.
There are three main types of cardiomyopathy:
Hypertrophic—can be divided into two types:
- Hypertrophic obstructive cardiomyopathy (HOCM)—the muscle between the two valves of the heart becomes so enlarged that it obstructs the blood flow in the heart
- Non-obstructive hypertrophic cardiomyopathy—non-obstructive form, the enlarged muscle is not large enough to block blood flow
HCM can occur in people of all ages. But, it is usually most severe when it occurs in younger people. The diagnosis is only made in people who do not have other causes of cardiomyopathy (eg,
or valvular heart disease, etc.)
Those with HCM are at an increased risk of sudden death. However, many individuals with HCM live a normal, healthy life with very few symptoms.
Normal Heart and Heart With Hypertrophic Cardiomyopathy
Copyright © Nucleus Medical Media, Inc.
Causes of HCM include:
- A gene that causes the abnormal structure of the heart muscle. It can be inherited or can happen from changes in the genes over time.
- A defective gene that controls growth of the heart muscle
- A viral infection
In people over age 60, HCM is likely to be caused by or related to
high blood pressure.
These factors increase your chance of developing this condition. Tell your doctor if you have any of these risk factors:
- Having a family member with HCM
- Being over age 60 and having hypertension
- Chest pain
- Fainting, particularly during exercise
- Dizziness or lightheadedness, particularly following exercise
- Heart palpitations
- Shortness of breath or difficulty breathing
- General fatigue
- Tiring easily during exercise or activity
- Shortness of breath when lying down
These symptoms can be caused by some of the side effects of the condition, including
(abnormal heart beats). The blocked or reduced blood flow is usually the cause of symptoms like dizziness, fainting, and difficulty breathing.
Your doctor will ask about your symptoms and medical history, and perform a physical exam.
Tests may include the following:
- Stress test
—tests how the body responds to exercise, which can help in detecting heart and lung problems
—uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart
- Transesophageal echocardiogram
—images of the heart are taken to detect abnormalities
Heart monitor—a portable
records continuous heart activity usually over a 24-72 hour period to determine regularity of the heartbeat
Heart catheter—a catheter is inserted into an artery in the groin area and threaded to the heart chambers
An x-ray machine shows real-time images of your body as a dye is injected through the catheter. This allows
(photos) to be taken of the blood vessels and the heart.
- Blood tests
- Chest x-ray
—uses radiation to take a picture of structures inside the body, especially bones.
Treatment focuses on controlling symptoms and preventing complications. Talk with your doctor about the best treatment plan for you. Treatment options include:
Medications may be used to help maintain proper and regular heart function. These may include beta-blockers and calcium channel blockers.
If you have an arrhythmia, you may need anti-arrhythmic drugs. You may also need blood-thinning medication.
The thickened portion of the heart muscle is cut and removed. This may be needed if you have a severely blocked blood flow from the heart.
If the mitral valve is leaking, surgery may also be done to repair or replace the mitral valve.
Alcohol is injected into the arteries of the thickened portion of the heart. This helps to reduce the blockage in the heart and improve blood flow out of the heart.
is implanted if you are at heightened risk for sudden death.
To help reduce your chances of getting HCM, take the following steps:
- If you have a family member who has been diagnosed with HCM—you and other family members should be screened for the condition
- If family history puts you at higher risk for HCM—regular echocardiograms may reduce the risk of death or complications from HCM
- If you have high blood pressure—take medications and follow other instructions as directed by your physician.
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Cardiomyopathy. American Heart Association website. Available at:
Accessed June 26, 2007.
Cleveland Clinic Heart and Vascular Institute.
Hypertrophic cardiomyopathy. The Cleveland Clinic Heart and Vascular Institute website. Available at:
Accessed June 26, 2007.
DynaMed Editorial Team.
Hypertrophic cardiomyopathy. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed/what.php. Updated October 25, 2010. Accessed November 5, 2010.
Erwin JP, Nishimura RA, et al. Dual chamber pacing for patients with hypertrophic obstructive cardiomyopathy: a clinical perspective in 2000.
Mayo Clin Proc
The HCM Program. St. Luke's Roosevelt Hospital Center website. Available at:
Accessed June 26, 2007.
Maron BJ, Nishimura RA, et al. Assessment of permanent dual chamber pacing for patients with hypertrophic cardiomyopathy.
Mayo Clinic. Hypertrophic cardiomyopathy. Mayo Clinic website. Available at:
http://www.mayoclinic.com/health/hypertrophic-cardiomyopathy/DS00948. Updated March 25, 2009. Accessed November 5, 2010.
McCully RB, Nishimura RA, et al. Extent of clinical improvement after surgical treatment of hypertrophic obstructive cardiomyopathy.
Last reviewed September 2013 by Michael J. Fucci, DO
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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