Medication after septal myectomy

[patkir]

I know this question was probably answered at other times but I have not bee on for awhile. I had a septal myectomy 2 years ago at CCF. I have been walking 8 miles a day with no cardiac symptoms and in my last echo I had a provokable gradient of 3 with valsuva and no gradient with my last check up. I have had numerous opinions over wheter I should be on medications. One said a small dose of verapamil an other said there was no need. I am absolutely confused. What is the position of the HCM?? I actually go better with no medication but don't want to do any damage. Patkir

[mtlieb]

Hiya Patkir,

It is quite common to continue taking meds after having a septal myectomy, in fact I'd say the majority of us still do to some degree. A myectomy adresses the specific issue of obstruction which effects about 25% of us, but regardless of how successful the myectomy is, you must remember that you do still have HCM and all the wonderful things that go along with it.

While it is true that in obstructed HCM'ers the majority of symptoms tend to be caused by the obstruction itself, and a myectomy serves to relieve those symptoms, there are other reasons to remain medicated beyond symptom relief. An HCM heart, obstructed or not, can stiffen over time. Our meds help to relax things a bit and keep our hearts pumping well without being overworked. There is a certain amount of remodeling that takes place within the heart after a myectomy as well. It's a dynamic organ which is always adapting and changing. Our meds can act as much as a prophylaxis for us as they do for symptom relief. You may want to discuss with your doctor a smaller dose of med that will have fewer side-effects, while at the same time maintaining the long-term benefit.

Others will chime in here as well and add their own 2 bits, but that's my own take on the situation. Only your HCM specialist can decide what's right for you, but most of us who have had myectomies do stay on some sort of medication afterwards.

Hope this helps,

Jim

[amyshields]

Since my myectomy last November, I have taken both atenolol and verapamil. I also still take 6 baby asprin daily. I did taper off medication once but found that my symptoms increased a bit when not on anything.

It is important to remember that each HCM'er is different so there is no one answer for all. I have found that there is a delicate balance between what my local cardiologist recommends and what I am comfortable with. Does that make sense? There have been a couple of times I have also consulted with my cardiologist at Mayo (Gersh) to make sure I am on the right track.

[Linda]

Patkir, What did they tell you at Cleveland? Do you go back for rechecks? Why not call the HCMA office and get some input there. Each person is different and there may be a very specific reason for your case. If you have questions about it, you prob have good reason to be uncertain. Keep asking questions till you get satisfactory info. Best wishes - Linda

[THW]

Check with Lisa for her opinion, but I'm pretty sure she is going to tell you that she would prefer to see ALL HCMers on at least a low dose of medication (i.e. beta blocker), symptoms or not, just to help the heart to contract more gently, in an effort to reduce the amount of 'wear and tear' on it over time.
Theresa