Staying Active After an HCM Diagnosis
- Living with hypertrophic cardiomyopathy (HCM) can be challenging for some, but there are lifestyle changes — like regular exercise — that can help.
- People with HCM should talk to their doctors about which types of exercise they can do and which to avoid.
- Because strenuous activity can make the condition worse, certain workouts should be avoided. However, moderate activity is encouraged by experts.
Hypertrophic Cardiomyopathy Overview
Hypertrophic cardiomyopathy (HCM) is a disease that causes the heart muscle cells to enlarge and the walls of the heart chamber (left ventricle) to become abnormally thick. This can make it harder for blood to be pumped effectively by the heart, as the heart chamber size has reduced. The flow of blood through the heart may also become obstructed. This, in turn, can lead to various complications and, in a small number of cases, life-threatening abnormal heart rhythms (arrhythmias) or even sudden death.
Read MoreDiagnosing HCM
The diagnosis of HCM will depend on the results of several tests, such as an echocardiogram (ECG), that are performed. Very few people are actually diagnosed with HCM – with approximately 100,00 people out of 750, 000 (estimated people to have HCM) in the United States being formally diagnosed. Dr. Philip Weintraub, a cardiology specialist based in New York, explains to Survivornet that “hypertrophic cardiomyopathy, when not diagnosed and not treated, carries a high incidence of sudden death”.
Symptoms of HCM
Signs and symptoms that might manifest and can be used for early diagnosis of HCM include the following:
- Shortness of breath, especially during exercise
- Chest pain, upon exertion
- Fluttering, fast, or pounding heartbeats (palpitations)
- Fainting, during or just after exercise
- Heart murmur
- Fatigue
“There could be no symptoms, and, if there are symptoms, typically they will start off as shortness of breath, or … shortness of breath on exertion,” Dr. Weintraub, says “The development can progress to where there will be chest pains. There could be chronic fatigue. There could be elements of feeling faint [or] passing out.”
Dr. Weintraub adds: “So, the spectrum is rather great, and it is associated with the severity of the cardiomyopathy itself. Symptoms, when they occur, generally lead to a dialogue between patient and physician and the physician must keep all options open as to what might be going on.”
Although a number of different conditions can cause fast pounding heartbeats or shortness of breath, it is important to seek out medical care to confirm a diagnosis and start the appropriate treatment. If you know of anyone in your family with HCM or have any symptoms such as chest pain, difficulty breathing, or irregular/rapid heartbeat, it may be advisable to see your healthcare provider.
Treatment Guidelines for HCM
There are many different approaches that your doctor may recommend in treating hypertrophic cardiomyopathy. For some people, certain drugs, surgical approaches, and a combination of methods may be needed, while others may be able to control their symptoms with lifestyle changes.
The American College of Cardiology and American Heart Association has released updated (2020) hypertrophic cardiomyopathy treatment guidelines aimed at providing recommendations that are applicable to those with HCM or who are at risk of developing cardiovascular disease.
Living with Hypertrophic Cardiomyopathy
Some people may be able to avoid medical interventions by changing their lifestyles and implementing healthy habits. As we’ve said before, HCM is a condition of the heart. So, developing heart healthy habits are essential.
“HCM must be looked at as a lifestyle changer,” Dr. Weintraub added.
His advice? For starters, people living with HCM should avoid any illicit drug use and cut back on alcohol consumption.
“You don’t want to invite other agents that might be toxic to the heart muscles,” he said. “You do not want to use illicit drugs, especially cocaine. You don’t want to use alcohol because alcohol itself could act as a depressant.”
Otherwise, he recommends that HCM patients adopt the following healthy habits:
- Moderate exercise
- Maintain healthy weight
- Normal sleep schedule
- Discuss/manage stress
- Avoid substances that put a strain on the heart
- Minimize salt intake
Additionally, Dr. Weintraub suggests people with HCM should prioritize finding a strong support system as they navigate life with the disease.
“You need to live in an environment where you can share what’s going on with you because we see many patients who are afraid of what’s wrong with them. They may even withdraw, isolate, and develop certain types of depressions,” he explained.
Hypertrophic Cardiomyopathy and Exercise
Dr. Aeshita Dwivedi, a cardiologist at Lenox Hill Hospital, also spoke with SurvivorNet about the importance of exercise.
“Living with hypertrophic cardiomyopathy can be challenging for a lot of people,” she told SurvivorNet. “But it is important that you follow up with your doctor regularly and get the right treatment. But in addition to that, it’s also important that you remain active, which means moderate activity.”
“Moderate activity” will look different from person to person. For some, it may mean going on 20-minute walks a few times a week, while others may be able to engage in slightly more strenuous activities. Your doctor should be able to offer recommendations based on your individual situation and overall health.”
“A lot of patients with hypertrophic cardiomyopathy are restricted from doing strenuous activity because it can actually make their condition worse, but it’s important to still stay active,” Dr. Dwivedi added.
She even mentions that people with HCM should consider “a supervised exercise program” to help them stay active in a safe way, if needed.
Hypertrophic Cardiomyopathy Exercise Restrictions
The risk of sudden death or arrhythmias with HCM is higher during exercises or training at a high intensity than at rest. Sports such as basketball, football, and swimming are associated with a higher risk of disease complications than less intense sports.
It is important to note that not everyone with HCM has the same level of risk when it comes to exercise. Some people are at a higher risk of sudden death or complications during mild/moderate exercise while others with HCM are able to participate in extremely competitive and strenuous sporting events without incident.
Determining individual exercise restrictions will be decided by you and your healthcare team to reduce any risk of sudden cardiac arrest or other severe complications. This is done by testing, taking patient history, and conducting a physical examination. Your doctor will also conduct tests to determine if you may benefit from an implanted cardiac defibrillator (ICD).
Your healthcare team may also order a cardiac stress test (cardiac exercise test), which is used to measure the heart’s response to physical exertion in a controlled environment. This helps to determine if you are experiencing any exercise-induced cardiac arrhythmias.
Exercise may not be suitable for those with any of the following:
- Significant left ventricular outflow obstruction
- A history of cardiac arrest
- Cardiac dysfunction attributed to HCM
- Abnormal blood pressure response to exercise
- Symptoms that suggest a serious cardiac arrhythmia
“You want to exercise regularly, but to avoid isometrics weight lifting,” Dr. Weintraub said. “You want to keep your weight at a healthy weight. You don’t want to put more strain on an over-strained system by allowing obesity to settle in.”
Moving Forward – Questions to Ask Your Doctor
- What forms of exercise would you recommend me doing?
- Are there any activities I should avoid because of HCM?
- Are there any important lifestyle changes I should be making besides exercising?
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