Hypertrophic cardiomyopathy (HCM) is a disease of muscle tissue in the heart that affects as many as 1 in 500 people in the United States, making it the most common inherited cardiomyopathy (heart muscle disease).

Although HCM does not cause symptoms for many people, it can lead to dangerous complications for others. Treatments for HCM include medication, surgery, implanted devices, and lifestyle modifications. The right treatment will vary based on your health.

What Is Hypertrophic Cardiomyopathy?

HCM is an inherited disease caused by certain gene mutations. The condition causes the walls of the left ventricle to become thickened, a condition called left ventricular hypertrophy. This thickening can prevent the heart from pumping oxygen-rich blood to the body.

HCM can cause various symptoms, including:

• Shortness of breath
• Dizziness
• Palpitations (racing, fluttering, or pounding heartbeat)
• Chest pain
• Fainting
• Arrhythmia (irregular heartbeat)

Symptoms often only appear when a person is exercising or performing strenuous physical activity. Some people with mild HCM may not experience any symptoms, while people with severe HCM may experience symptoms even while resting. HCM can cause complications, such as arrhythmias, heart failure, and even cardiac arrest.

Treatment options for HCM vary based on the features and health complications an individual has.

Treating Hypertrophic Cardiomyopathy

The best treatment option for you will depend on your specific case of HCM. Your doctor will consider which specific parts of the heart are involved and whether you are experiencing complications.

If you don’t have symptoms from HCM, you may not need treatment. However close follow-up with a cardiologist is recommended. Your doctor may recommend regular echocardiograms to check for any changes in your heart.

HCM can be a complicated disease to treat. It is important to get care from doctors with experience treating it. For some surgeries unique to HCM, it is especially important to have surgeons with a great deal of experience.

For more details on common HCM treatments, check out the following four options.

1. Medication

Medication is the first line of treatment for HCM. Medications used to treat HCM include:

• Beta-blockers — These slow the heart’s rhythm and allow it to beat with less force. Examples include metoprolol (sold as Lopressor and Toprol-XL) and propranolol (Inderal and Innopran XL).
• Calcium channel blockers — These drugs prevent irregular heartbeat, relax blood vessels, and keep the heart from contracting too strongly. Diltiazem (sold as Cardizem and Tiazac) and verapamil (including the brands Verelan, Covera-HS, and Calan) are examples.
• Antiarrhythmic drugs — These medications, which include sodium channel blockers and potassium channel blockers, prevent irregular heartbeat. Your doctor may prescribe amiodarone (Pacerone) or disopyramide (Norpace).
• Anticoagulants — Also called blood thinners, these help prevent blood clots and stroke. Apixaban (Eliquis) and rivaroxaban (Xarelto) are examples of commonly used blood thinners.
• Cardiac myosin inhibitor — This type of treatment helps the heart muscle relax. Mavacamten (sold as Camzyos) is the first of this type of treatment to be approved by the U.S. Food and Drug Administration (FDA) for HCM. It was approved in 2022.

2. Surgery

If medication does not sufficiently control your condition, your doctor may recommend surgery to treat HCM. Surgical procedures for HCM can include:

• Septal myectomy — Reduces the thickness of the interventricular septum — the wall that divides the heart between left and right ventricles
• Alcohol septal ablation — Reduces interventricular septum thickness without invasive surgery
• Transapical myectomy or apical aneurysm repair — Treats problems in the lower tip, or apex, of the left ventricle
• Heart valve surgery — Repairs damage to the mitral valve or replaces the mitral valve — the valve that separates the left atrium from the left ventricle
• Cardiac ablation — Stops abnormalities like irregular heartbeats, using a catheter or, less commonly, heart surgery
• Heart transplant — Used in cases of severe HCM with heart failure

3. Implantable Devices

Implantable devices can be used to help control heart rate, prevent sudden cardiac death, regulate heartbeat, and help synchronize heart contractions. Devices include:

• Implantable cardioverter defibrillator (ICD) — Prevents sudden cardiac death by “shocking” the heart to correct dangerous arrhythmias
• Pacemaker — Used to help correct abnormal heart contractions and prevent the heart from beating too slowly
• Left ventricular assist device — Used to treat severe heart failure to help the heart pump blood to the body

4. Lifestyle Changes

Certain lifestyle changes can help improve HCM symptoms. Regular mild to moderate exercise is recommended for most people with HCM. Avoiding competitive sports or intense exercise is also recommended, depending on how severe the HCM is.

Maintaining a healthy body weight can help the heart function better and prevent problems such as sleep apnea and high blood pressure that can make HCM worse.

What Determines the Best Treatment for Hypertrophic Cardiomyopathy?

Current guidelines for treating HCM recommend first-line treatments and advanced treatments based on specific circumstances. Medication is always the first choice, and the medications used depend on the features of HCM that are present. Surgical procedures and implantable devices are used when medication fails to achieve treatment goals.

Communication with your doctor is important when determining which treatment options are best for you. It is important to have two-way communication with your doctor to find treatments that support your goals and your circumstances.

Obstructive HCM

Obstructive HCM (HCM with left ventricular outflow obstruction) is caused by thickening of the interventricular septum. If the septum becomes too large, it can interfere with normal blood flow.

Treatment for obstructive HCM begins with beta-blockers and calcium channel blockers. If these medications aren’t effective, you may need different calcium channel blockers or potassium channel blockers in addition to beta-blockers.

Alcohol septal ablation or a septal myectomy procedure may be needed if medication isn’t enough to treat obstructive HCM. Surgery to repair damage to the mitral valve may be recommended.

Nonobstructive HCM

Nonobstructive HCM is treated with beta-blockers and calcium channel blockers first. Diuretics, or water pills, may be used to treat shortness of breath in nonobstructive HCM.

HCM With Atrial Fibrillation

Atrial fibrillation (AFib) is a heart condition in which the heart’s upper chambers (atria) beat irregularly and out of sync with its lower chambers. Beta-blockers and calcium channel blockers are the first-line treatment for AFib — but amiodarone, an antiarrhythmic drug, may also be prescribed.

Anticoagulants may be used to prevent blood clots and stroke. A pacemaker may be needed if medication doesn’t effectively treat AFib.

HCM With Ventricular Arrhythmia

Ventricular arrhythmias caused by HCM can be life-threatening and usually require an ICD to prevent sudden cardiac death. Medication is used to help control arrhythmias, including beta-blockers and antiarrhythmic drugs.

If medication does not work, then ablation may be needed. Additionally, surgery may be needed to treat an apical aneurysm in the left ventricle, essentially a pouch of thinner heart muscle at the tip of the ventricle. A heart transplant may be needed if heart function is severely impaired.

HCM With Heart Failure

Heart failure is one of the more serious and debilitating complications of HCM. Beta-blockers and calcium channel blockers may be used to treat HCM and heart failure, as well as an ICD.

Severe heart failure may require a left ventricular assist device or heart transplant.

Talk With Others Who Understand

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