Key takeaways

  • If you have hypertrophic cardiomyopathy (HCM) and are experiencing symptoms such as shortness of breath, chest pain, dizziness, and difficulty exercising, your doctor might suggest that you start taking medication.
  • Medications for HCM help slow down your heart rate so your heart can pump blood more effectively. They also help relieve symptoms and improve your capacity for exercise.
  • Doctors will typically first prescribe a beta-blocker or calcium channel blocker to manage HCM and may add other medications in some cases. You’ll have office visits, echocardiograms, and EKGs regularly so your doctor can monitor how well your medications are working.

The role of medications in HCM is centered on improving symptoms, lowering the outflow tract gradients (making it easier for your heart to pump blood out), increasing diastolic filling time (the time it takes your heart to fill with blood between beats), reducing symptoms caused by fluid overload, and preventing any arrhythmias (abnormal heart rhythms).

Essentially, medications help reduce how hard your heart squeezes while also slowing down your heart rate to enable your heart to pump blood better, leading to an improvement in exercise tolerance.

Newer medications that have hit the scene in the treatment of HCM, such as mavacamten, decrease the hypercontractility of the heart (the strength of the heart muscle’s contractions) and help improve exercise capacity in people with HCM who are experiencing symptoms.

Dyspnea (shortness of breath) during physical activity is a common symptom.

Other symptoms include:

  • palpitations (a feeling as if your heart is fluttering or skipping a beat)
  • rapid heart rate
  • chest pain
  • dizziness
  • a faint or lightheaded feeling and loss of consciousness (passing out)
  • new or worsening fatigue
  • difficulty exercising

Different factors determine which medications need to be started. Typically, a beta-blocker is first-line treatment for obstructive and nonobstructive cardiomyopathy. A calcium channel blocker is an alternative to a beta-blocker, as both drugs can decrease heart rate and contractility.

If people with HCM are having palpitations from atrial arrhythmias, doctors may prescribe medications like amiodarone, sotalol, and anticoagulants.

If a person has any evidence of heart failure, then a doctor would prescribe diuretics.

Mavacamten is a drug used in people with an elevated left ventricular outflow gradient who still have symptoms despite receiving optimal treatment.

After you start medications for the treatment of HCM, you’ll need to attend routine office visits, which are complemented by echocardiograms (especially if you’re taking a myosin inhibitor) and electrocardiograms (EKGs). You may also need to wear a Holter monitor if your doctor is concerned about palpitations or arrhythmias.

It’s always good to ask why the doctor is recommending that you start any medication.

Other questions to ask include:

  • What side effects should I watch out for?
  • Can this medication lower my blood pressure or heart rate?
  • Could this medication interact with anything else I take?
  • Should I avoid any activities while taking this medication?
  • How often will I have follow-up appointments or repeat echocardiograms?
  • What should I do if my symptoms worsen?
  • What are my other options if this medication does not work?

Dr. Uzochukwu Ibe is an ABMS board certified internal medicine physician and a general cardiologist. He completed his fellowship in interventional cardiology in Ohio and now practices in Missouri.