What Symptoms Does Hypertrophic Cardiomyopathy Cause?
There is no particular symptom or complaint which is unique to Hypertrophic Cardiomyopathy. Symptoms may occur at any stage in a person’s life even though the condition may have been present for some time. The reason for the onset of symptoms is often not clear.
It should also be mentioned that some “symptoms” of HCM may be under appreciated even by the patient. This is typically due to the fact that HCM is present in most people for years prior to identification, they may have grown accustom to feelings that an otherwise “healthy” person would notice immeadiately should they “walk a mile in the HCM patient’s shoes”.
Symptoms are listed in no particular order.
Shortness of Breath
Exercise capacity may be limited by breathlessness and fatigue. Most individuals experience only mild exercise limitations, but occasionally limitation is severe and a minority may have shortness of breath at rest.
Chest pain is a common symptom. It is usually brought on by exertion and relieved by rest, but pain may occur at rest or during sleep and may persist. The cause of the pain is thought to be insufficient oxygen supply to the myocardium. In Hypertrophic Cardiomyopathy the main coronary arteries are usually normal, but the greatly thickened muscle demands an increased oxygen supply which cannot be met in some circumstances.
Palpitation is an uncomfortable awareness of the heart beat. People may occasionally feel an extra beat or a skipped beat and this is usually normal. Sometimes an awareness of the heart beating does suggest an irregular heart rhythm. In this case, palpitation may start suddenly, appear to be very fast and may be associated with sweating or light-headedness. The cause of such episodes should be determined and treated.
Light-Headedness and Blackouts
Persons with the condition may experience light-headedness, dizziness and more seriously, blackouts. Episodes may occur in association with exercise, with palpitations or without any apparent provocation. The reasons for these episodes are not always clear. They may be due to an irregularity of the heart beat, or fall in blood pressure. Episodes of light-headedness and certainly a blackout should be reported to one’s doctor and investigated.
Most commonly seen “misdiagnosis” associated with HCM?
Most commonly seen is asthma, specifically ‘athletically induced asthma” as a first sign or symptom. This is likely due to transient shortness of breath often seen in HCM. It is also common to have a diagnosis of “mitral valve prolapse” prior to a proper diagnosis of HCM. This often happens upon an audible murmur that is thought to be simply mitral valve prolapsed, a common condition. It is not uncommon to see people diagnosed with anxiety attacks, panic attacks or some forms of depression only to find that the underlying cause of the symptoms is HCM.
Maron, B.J. and Salberg, L. Hypertrophic Cardiomyopathy: For patients, their families and interested physicians. Blackwell Futura: 1st edition 2001,81 pages; 2nd edition 2006, 113 pages; 3rd edition pending publication 2014
Gersh, B.J., Maron, B.J., Bonow, R.O., Dearani, J.A., Fifer, M.A., Link, M.S., et al. (2011). 2011 ACCF/AHA guidelines for the diagnosis and treatment of hypertrophic cardiomyopathy. A report of the American College of Cardiology Foundation/American Heart Asociation Task Force on practice guidelines. Journal of the American College of Cardiology and Circulation, 58, e212-260.
Maron BJ, McKenna WJ, Danielson GK, Kappenberger LJ, Kuhn HJ, Seidman CE, Shah PM, Spencer WH, Spirito P, ten Cate FJ, Wigle ED. American College of Cardiology/European Society of Cardiology Clinical Expert Consensus Document on Hypertrophic Cardiomyopathy. A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines Committee to Develop an Expert Consensus Document on Hypertrophic Cardiomyopathy. J Am Coll Cardiol 2003;42:1687-1713 and Eur Heart J 2003;24:1965-1991.
HCMA patient survey 2014, 2007