Obstructed Vs. Non-Obstructed

[Bucky]

It seems to me that it is better to be obstructed than not. At least if you are obstructed you have some chance (Myectomy) of getting some relief from symptoms.

If you are non-obstructed you are left with drugs which might or might not provide some relief....

Just an observation and I'll be interested in the comments.

[mtlieb]

Hi Bucky,

I've given this plenty of thought over the years and have come to the conclusion that it is not in fact better to be obstructed... and can sometimes be worse. Couple of things to think about:

Even if the obstruction is effectively relieved through surgery (which is often the case)... in the end you still have HCM just like everyone else here, and will retain varying degrees of symptoms. It's not a cure.

Myectomy and/or alcohol ablation can leave you with A-Fib, a pacemaker, or other complications from surgery that you would not have otherwise experienced.

Many of our transplant patients, and also some people we have lost here recently, were obstructed folks for whom myectomy was not ultimately successful and they proceeded to end-stage HCM after that. Several of our current members are in that same boat.

Obstruction, if left untreated or undiagnosed, increases your risk of sudden death and is a predictive factor toward progression into heart failure and early death (Maron et al, 2003).

The heart remodels after myectomy... sometimes for the better, sometimes for the worse.

Obstruction causes significant wear and tear on the mitral valve and other parts of the heart that non-obstructed people do not experience. Surgical intervention for the obstruction can also require mitral valve repair or replacement which pose additional risk factors.

If myectomy is unsuccessful, you either accept what symptoms you're left with, or you go on the transplant list. If you are fortunate, a heart will become available. We lost Tommy from the board here recently because he was not so fortunate.

None of this is to say that myectomy should be avoided or approached with skepticism. It is the best intervention for obstructed folks and the majority of patients see a great improvement in symptoms. I just wanted to show the flip-side of the coin and provide a balanced view.

Obstruction isn't any better or worse than being non-obstructed. It just is what it is.

Jim

[Bucky]

Jim:

Thanks so much. Great information. One more question.

If you are obstructed only during exercise, but unobstructed at rest does that make a difference. I don't know if that is my case or not at this point, but just curious.

Ie, should a person who feels relatively good "schlepping around" the house and not putting a great load on the heart, but who when he or she starts out on a brisk walk, has problems with SOB, palpitations, etc. consider myectomy or just be content with "schlepping".. Probably no definite answer. Heck during football season is when I "schlepp" the best. Too bad football season doesn't last all year...I would be cured.

Thanks.

Doug (aka Bucky)

[jorgusen]

You are either obs or non,,,it doesnt change do to level of excertion. Your gradient may change. As for excercising,as noted many times before, it is an indivual thing to be discussed with your cardio doctor. I believe if you can ,,its a great things

[Bucky]

Not to argue, but I swear I've read articles about people who are non obstructed except during a load on their heart. But, probably as you say......you're obstructed all the time, it is just the pressure gradient that increases as you interfere more with the valve and the outflow.

Thanks for the information. All is helpful.

Doug

[Cynaburst]

Doug - You are actually correct. You can be non obstructed when resting and still be obstructed when your heart is placed under stress. That is called a provocable gradient. Also, you can have some times when you are resting and have no obstruction, and have other times when you are resting and DO have obstruction. It depends on your hydration level, as well as various other physiological factors.