Treatments for Hypertrophic Cardiomyopathy

The treatment for hypertrophic cardiomyopathy (HCM) depends on the severity of the muscle thickening in your heart, the presence or absence of outflow tract obstruction and what your care team determines your risks to be.

The majority of patients with no symptoms and with a normal heart rhythm require no specific treatment. However, we recommend that patients with HCM not participate in strenuous physical activity or competitive sports.

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Treatments for HCM include:

  • Periodic follow-up visits with your care team to assess changes in heart function.
  • Medications: Beta-blockers (slow the heart rate and reduce the heart’s force of contraction) and calcium channel blockers (improve the filling of the heart by reducing its stiffness) are useful to control symptoms like shortness of breath, palpitations (abnormal extra sound made when the heart beats), lightheadedness or chest pain. Although medications are usually started at low doses, higher doses may be necessary if symptoms are not completely controlled.
  • Electrical cardioversion and medications for certain heart rhythm abnormalities.
  • Implantation of a defibrillator for those patients deemed to be at increased risk of sudden death due to potentially serious heart rhythm abnormalities caused by HCM. A defibrillator detects very rapid, life-threatening heart rhythms and delivers an electric current to the heart to restore normal rhythm.
  • Implantation of a pacemaker for those patients deemed to be at increased risk of fainting because of abnormally slow heart rhythms. A pacemaker detects very slow heart rates and then delivers a current to the heart at the proper rate to restore a normal heart rate.
  • Cardiac surgery for those patients with severe symptoms who have marked outflow obstruction due to the thickened heart muscle. This is usually performed in patients in whom symptoms continue or worsen despite drug treatment. The operation is called septal myectomy, which involves surgically removing a portion of the thickened muscle that is responsible for blocking the flow of blood out of the heart. In some patients, the surgeon also repairs the mitral valve if the thickened muscle is making the valve leak severely. In patients with atrial fibrillation (chaotic or abnormal electrical signals or pathways in the atria resulting in an irregular heartbeat) the surgeon performs a Maze procedure, which has a very high success rate in curing atrial fibrillation.
  • Heart transplantation for those patients with HCM who develop advanced heart failure that cannot be effectively treated by the above means.