Cardiomyopathy refers to a disease that affects the heart muscle. There are several kinds of cardiomyopathies. Hypertrophic cardiomyopathy (HCM) is a form that you inherit through genes. It is the most common form of inherited heart disease.
There are two types of HCM — obstructive and non-obstructive. Obstructive HCM blocks or reduces blood flow and is the most common. Non-obstructive HCM still causes the thickening of heart muscle but does not block the flow of blood.
Most people with HCM do not have symptoms or have only mild symptoms. However, severe complications of HCM can include congestive heart failure, stroke, and atrial fibrillation. Your doctor will make a personalized recommendation and will likely monitor symptoms.
For people who have symptoms of HCM, medications are the first step in treatment.
Medications to improve symptoms
The symptoms of HCM are due to the heart muscle becoming enlarged, thick, or stiff. These changes prevent the heart from pumping blood the way it should. This means your body’s tissues, including the heart muscle itself, are not getting enough blood. And the lack of blood flow is what causes many HCM symptoms, including:
- abnormal heart rhythms
- chest pain
- dizziness
- fainting
- lack of energy
- lightheadedness
- shortness of breath
- swelling in the feet or ankles
- tiredness
If you have HCM symptoms, doctors usually start with medications that help the heart work easier. By improving the way the heart pumps, these medications can help relieve symptoms.
Beta blockers work to slow the heart rate and reduce the force the heart uses to pump blood. They also work to lower blood pressure. This is another way beta blocker help the heart — lower blood pressure makes it easier for blood to flow.
Examples of beta blockers for HCM include:
- atenolol
- metoprolol
- nadolol
Like beta blockers, calcium channel blockers ease the work of the heart and lower blood pressure. Examples of calcium channel blockers for use in HCM include:
Disopyramide is an antiarrhythmic drug that can help with certain abnormal heart rhythms. However, it can also have some of the same effects as beta blockers and calcium channel blockers by reducing the workload on the heart.
Other medications for symptoms
Several other medications can manage the symptoms of HCM. These can include:
- antiarrhythmic drugs, which help manage abnormal heart rhythms: amiodarone (Nexterone), sotalol (Sotylize), dofetilide (Tikosyn)
- anticoagulants (blood thinners), which help prevent blood clots and stroke in people with atrial fibrillation (Afib): apixaban (Eliquis), warfarin (Jantoven, Coumadin)
- diuretics, which help get rid of extra fluid and eases the heart’s workload: furosemide (Lasix), bumetanide (Bumex)
Medications to improve symptoms and function
Until very recently, the only medications doctors had to treat HCM were the ones that relieved symptoms. That changed in 2022 with the approval of mavacamten (Camzyos).
This medication is different because it targets the cause of HCM. It is the first drug in a class of medications called myosin inhibitors. It targets the structure of the heart muscle and can have the following effects:
- reducing the thickness of the heart muscle
- improving blood flow through the heart
- increasing oxygen delivery to the tissues
- resolving mitral valve problems
These effects mean that mavacamten is modifying the course of the disease. During clinical trials, people who took mavacamten (Camzyos) had improvements in symptoms, self-reported health status, and quality of life.
Mavacamten (Camzyos) is approved to treat people who have the obstructive form of HCM with symptoms. This medication has a black box warning from the Food and Drug Administration (FDA). Before prescribing this drug, your doctor will evaluate the risks and benefits for your health. If your doctor recommends you start taking mavacamten (Camzyos), you will be enrolled in the Risk Evaluation and Mitigation Strategy (REMS) program to receive the drug.
The outlook for people with HCM has greatly improved over the past couple of decades. For many of them, medications can help effectively manage the disease.
If you have tried medications and symptoms are not improving, talk with your doctor. Other options for HCM treatment may alcohol septal ablation — which is a catheter-based procedure. It may improve symptoms, ability for physical activity, and obstruction.
There are also surgical options. Your doctor can help you consider next steps for long-term management of HCM.