Managing Hypertrophic Cardiomyopathy
Updated on 2/11/2009
How well the heart compensates for the structural abnormalities associated with hypertrophic cardiomyopathy is largely determined by overall physical fitness and health. People with HCM need to fully embrace a lifestyle that promotes fitness and heart health as well as minimizes exposure to factors that can deleteriously affect their condition.
Key guidelines include:
- Exercise regularly in moderation.
- Get regular dental care.
- Don't use over-the-counter (nonprescription) cold medications.
- Don't smoke.
- Don't use diet pills.
- Ask your physician if it's safe for you to drink alcohol and beverages with caffeine.
- Don't use street drugs such as cocaine and methamphetamine.
- Follow a heart-healthy diet.
- Practice techniques for reducing and managing stress.
- Do not use hot tubs or saunas.
This section includes more information on:
People with HCM should see a doctor at least once a year to discuss and evaluate any changes in their condition. Patients undergoing treatment may see their doctor more frequently depending upon the situation--three-month intervals while developing a drug therapy plan, six- to eight-week intervals for patients who have had recently undergone an invasive treatment such as myectomy or septal ablation.
Anyone with hypertrophic cardiomyopathy should see a doctor if they experience:
- Decrease in tolerance for activity
- Onset of any symptoms--chest pain, dizziness, fainting, or rapid heartbeat
- Sudden weight gain
- Unexplained fever
- Changes in breathing
Prevention of endocarditis
People with hypertrophic cardiomyopathy are at increased risk for contracting endocarditis and should follow measures to prevent this infection.
Endocarditis is a dangerous infection of the lining of the inside of the four chambers or the valves of the heart. Certain bacteria and other microorganisms that occasionally circulate in the blood can settle and multiply on the heart valves of people with HCM. Although effective treatments are available, endocarditis can lead to permanent damage of the heart valves or even heart failure.
Endocarditis is diagnosed using a combination of blood culture and special echocardiogram. If a child or an adult with HCM has a fever that cannot be attributed to a specific infection like strep throat or an ear infection, endocarditis should be considered.
Treatment of endocarditis may require four to six weeks or more of intravenous antibiotics and may include surgery. Penicillin (amoxicillin/ampicillin) and gentamicin are the most commonly used antibiotics, but other antibiotics can be used as well. Although powerful antibiotics are available, treatment can be difficult and endocarditis can have serious complications. Therefore people with hypertrophic cardiomyopathy should do all they can to minimize the risk of developing this infection.
To prevent endocarditis, people with HCM should take antibiotics prophylactically before medical procedures that may allow bacteria in the mouth, nose, or intestinal tract to get into the blood and circulating circulate to the heart. In some cases, the antibiotics will be administered intravenously and may include follow-up doses after the procedure. In other situations, the antibiotics are taken orally, one hour before the procedure. Detailed information on endocarditis treatment can be found on the American Hheart Association website.
It's important to note that most cases of endocarditis do not directly follow and are not caused by a dental procedure. More often, the endocarditis follows a minor gum injury or is caused by poor dental hygiene. Regular and comprehensive dental care is imperative for individuals with hypertrophic cardiomyopathy.
Individuals can do several things daily to guard against an endocarditis infection.
- Use good oral hygiene.
- Routinely brush and floss teeth and gums, and get regular checkups.
- Careful management of cuts or lesions. Cuts or lesions should be cleaned thoroughly and watched for signs of infection. A physician should be contacted if a cut or lesion is not healing well or looks infected.
- Do not have your body tattooed and/or pierced.
- Do not use intrauterine devices (IUDs) for birth control.
This section includes information on procedures for which endocarditis prophylaxis is recommended.
Procedures for which endocarditis prophylaxis is recommended
Although physicians and dentists are aware that people who are susceptible to bacterial endocarditis should be given antibiotics before procedures, it is a good idea to remind your doctor or dentist of congenital heart disease before any dental, surgical or special procedures are done. The American Heart Association has a wallet-sized card for this purpose on its website.
Dental procedures for which endocarditis prophylaxis is recommended:
- Routine teeth cleaning at the dentist's office
- Dental extractions
- Periodontal procedures including surgery, scaling, and root planing, probing, and recall maintenance
- Endodontic (root canal) instrumentation or surgery
- Subgingival placement of antibiotic fibers or strips
- Initial placement of orthodontic bands but not brackets
- Intraligamentary local anesthetic injections
- Prophylactic cleaning of teeth or implants
Respiratory tract procedures for which endocarditis prophylaxis is recommended:
- Tonsillectomy and/or adenoidectomy
- Surgical operations that involve respiratory mucosa
- Bronchoscopy with a rigid bronchoscope
Gastrointestinal procedures for which endocarditis prophylaxis is recommended:
- Exams or treatments with instruments--sclerotherapy for esophageal varices, esophageal stricture dilation, endoscopic retrograde cholangiography with biliary obstruction
- Surgical procedures--biliary tract surgery, colon resection, operations that involve intestinal mucosa, hemorrhoid removal, or polyp removal
Genitourinary procedures for which endocarditis prophylaxis is recommended:
- Surgical procedures--surgeries of the prostrate, bladder, gallbladder
- Exams or treatments with instruments--cystoscopy, urethral dilation
Regular aerobic physical activity such as walking and biking in moderation, as prescribed by your doctor, is beneficial for people with hypertrophic cardiomyopathy because it improves the overall cardiovascular systems and reduces stress. However, there are some limitations that should be discussed with your doctor, including:
- Do not participate in strenuous activities such as weight lifting.
- Do not participate in competitive contact sports such as football, soccer, or basketball.
- Avoid heavy lifting or strenuous physical activity at work and home.
- Stay hydrated with water and other caffeine-free beverages.
If one person has hypertrophic cardiomyopathy, members of the immediate family may also have it--and should be evaluated for HCM with an echocardiogram to determine the need for treatment.
Some first-degree relatives, such as children or siblings, of a person with HCM should have ongoing screening:
- Adolescents and anyone participating in competitive athletics or rigorous physical training should be evaluated for HCM, including an echocardiogram, annually.
- Adults who are not participating in competitive athletics or rigorous physical training should be evaluated for HCM with an echocardiogram every five years.
- More distant relatives, such as nieces and nephews, should be screened for HCM with an echocardiogram if they have a heart murmur themselves or a parent with an abnormal echocardiogram.
- While genetic screening doesn't seem to be helpful in finding people with HCM in the population at large at this time, it can be helpful to test the relatives of a patient whose genetic mutation has already been identified. Testing the child for the same genetic mutation can help determine that child's risk for developing HCM.
advertisement
