Acquired Hypertrophic Cardiomyopathy

Acquired Hypertrophic Cardiomyopathy

Article
Heart & Vascular Health
Diseases & Conditions
Contributed byMaulik P. Purohit MD MPHMar 25, 2018

What are the other Names for this Condition? (Also known as/Synonyms)

  • Aging-Associated Acquired Hypertrophic Cardiomyopathy
  • Diabetes-Associated Acquired Hypertrophic Cardiomyopathy
  • Hypertension-Associated Acquired Hypertrophic Cardiomyopathy

What is Acquired Hypertrophic Cardiomyopathy? (Definition/Background Information)

  • Acquired Hypertrophic Cardiomyopathy (Acquired-HCM) is a disease affecting the heart muscle. The term “hypertrophic” means enlargement of cells, which, in this condition, leads to a thickening of the heart muscle
  • The thickening can be in the 4 chambers of the heart, or the wall that separates the chambers. The lower left chamber of the heart (the left ventricle) may thicken, causing the inside of the left ventricle to become smaller
  • This reduces the ability of the left ventricle to relax sufficiently and hold enough blood in the chamber. Due to this, the chamber is forced to exertion, when pumping blood to the rest of the body. Additionally, the heart’s mitral valve can also be affected, causing blood to leak backward through the valve
  • Most cases of hypertrophic cardiomyopathy (HCM) are genetic. However, when the condition develops without a known genetic cause in association with, and because of another disease/disorder, it is differentiated from the heritable type of HCM, using the prefix “acquired”

Acquired Hypertrophic Cardiomyopathy is considered very rare; often, the disorder is associated with the following conditions:

  • Pituitary tumors causing abnormal increase in growth hormone production, leading to acromegaly
  • Neurofibromatosis, which causes tumors in the brain and spinal cord
  • Lipodystrophy, a disease with abnormality in body fat storage and utilization
  • Pheochromocytoma, an adrenal gland tumor that produces hormones
  • Uncontrolled diabetes
  • Thyroid disease
  • High blood pressure
  • Aging

Therefore, having any of the above-mentioned conditions places an individual at risk for developing Acquired-HCM.

  • Individuals with Acquired-HCM not only show symptoms of hypertrophic cardiomyopathy, but also of the underlying causative medical condition. The symptoms may include chest pain, shortness of breath, dizziness, fainting, and palpitations
  • The diagnosis may involve tests such as echocardiography (ECG), electrocardiography (EKG), stress test, and coronary catheterization. If required, a biopsy of the heart muscle may be ordered. Additional tests may be required for diagnosing/monitoring the causative medical condition
  • Some potential complications of Acquired Hypertrophic Cardiomyopathy include a backflow of blood into the heart (heart valve regurgitation), aberrant heart beats (arrhythmia), sudden cardiac arrest, and dilated cardiomyopathy
  • The condition may be treated with lifestyle changes, medications, non-surgical procedures, and surgical implants, depending on the severity of the condition. Treatment of any underlying condition responsible for heart muscle thickening is also addressed, as part of a comprehensive care
  • Proper glycemic control, management of thyroid disease, medication for high blood pressure, and providing appropriate treatment for tumors of the spinal cord, pituitary, and adrenal glands, may help in the prevention of Acquired-HCM
  • With timely diagnosis and sustained treatment, the condition is manageable. Additionally, the severity of the causative medical condition in Acquired Hypertrophic Cardiomyopathy can affect the outcome

Acquired Hypertrophic Cardiomyopathy can be classified as obstructive or non-obstructive:

  • Obstructive:
    • Blood flow blockage occurs in the left ventricle, forcing it to exertion, to pump blood to the rest of the body
    • It can also affect the mitral valve of the heart and cause blood to leak backward through the valve
  • Non-obstructive:
    • There is no blockage to blood flow in this condition
    • However, the pumping of blood becomes inefficient, when a part, or all of, the left ventricle becomes thicker

In both types, the heart muscle, particularly the left ventricle, gets thickened, causing the inside of the left ventricle to become smaller. This reduces the capability of the left ventricle to relax sufficiently and hold enough blood.

Who gets Acquired Hypertrophic Cardiomyopathy? (Age and Sex Distribution)

  • Acquired Hypertrophic Cardiomyopathy is a rare heart condition
  • Middle-aged and older individuals are more prone to this condition than younger individuals
  • There is no racial or gender bias in the occurrence of Acquired-HCM
  • Individuals with high blood pressure, poorly-controlled diabetes, thyroid disease, tumor(s) affecting the pituitary gland, spinal cord, and adrenal glands, and certain genetic conditions, such as lipodystrophy, are more vulnerable to Acquired-HCM

What are the Risk Factors for Acquired Hypertrophic Cardiomyopathy? (Predisposing Factors)

The following are some known risk factors for developing Acquired Hypertrophic Cardiomyopathy:

  • Chronic high blood pressure
  • Diabetes, particularly with poor glycemic control
  • Diseases of the thyroid gland
  • Excess growth hormone in the body (causing acromegaly), owing to a tumor affecting the pituitary gland
  • Hormonal imbalances due to tumor in adrenal glands (pheochromocytoma)
  • Tumors of the brain and spinal cord (neurofibromatosis)
  • A genetic disorder in body fat generation, storage, and distribution, known as lipodystrophy
  • Advancing age

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Acquired Hypertrophic Cardiomyopathy? (Etiology)

Acquired Hypertrophic Cardiomyopathy is caused by certain medical conditions, which influence the muscles of the heart. These include:

  • Chronic high blood pressure, which leads to thickening of the left ventricle
  • Poorly-controlled diabetes: The exact cause is not known, but diabetes can cause structural changes in the heart
  • Thyroid disease: The exact cause of heart muscle thickening as a consequence of decreased or increased thyroid hormone is not understood. Both conditions can cause changes in the consumption of oxygen by heart muscles, as well as muscle contractility in the heart
  • Lipodystrophy: It is a genetic condition that results in abnormal formation, storage and distribution of fat. Individuals with a mutation in seipin, an integral membrane protein, exhibits a strong correlation with cardiomyopathy. The majority of affected individuals have insulin-resistant diabetes, high cholesterol and triglyceride levels, all of which can lead to thickening of the heart muscle
  • Acromegaly: Abnormal increase in growth hormone, as a result of a benign pituitary tumor, can cause aberrant growth of external and internal tissue. The thickening of heart muscles is a known outcome of this disorder
  • Pheochromocytoma: It is an adrenal gland tumor that can cause acute or chronic high blood pressure in the affected individual. The blood pressure changes are caused by the release of catecholamines, which control involuntary muscle movement in the body, such as those of the heart
  • Neurofibromatosis: The tumors formed in this genetic condition are known as neurofibromas that cause high blood pressure to develop in the affected individuals

What are the Signs and Symptoms of Acquired Hypertrophic Cardiomyopathy?

The signs and symptoms of Acquired Hypertrophic Cardiomyopathy include: 

  • Chest pain
  • Dizziness, fainting
  • Shortness of breath, particularly with physical exertion (exertional dyspnea)
  • Shortness of breath, while lying down (orthopnea)
  • Shortness of breath and coughing while sleeping (nocturnal paroxysmal dyspnea)
  • Fatigue
  • Palpitations; a sensation of rapid fluttering or pounding heartbeat
  • Heart murmurs: It is an unusual sound heard during the heartbeat. This can be an extra beat or whooshing/swishing sound, and may be faint or loud
  • Swelling of ankles, legs, abdomen, or veins in the neck
  • In addition to the above, the affected individuals may also exhibit additional symptoms, depending on their pre-existing medical condition

The symptoms may be any or many of the above. There may be variations in degree of severity from one individual to another.

Note: In some cases, the condition may be completely asymptomatic and sudden fainting may be the first presentation of Acquired-HCM.

How is Acquired Hypertrophic Cardiomyopathy Diagnosed?

The diagnosis of Acquired Hypertrophic Cardiomyopathy is made with the help of information gathered from the following tests and procedures:

  • A thorough physical examination and an assessment of symptoms
  • Evaluation of personal and family medical history
  • Chest X-ray to check for heart size, contour, and fluid build-up in lungs
  • Electrocardiogram (EKG) to check the heart’s electrical activity
  • Echocardiography (ECG or echo) uses sound waves to create a moving picture of the heart. This helps to check the size, shape, and pumping function of the heart
  • Stress test: This test places stress on the heart by making it work harder and beat faster to determine, if the cardiac muscles can cope with the increased workload
  • Cardiac catheterization: To check for pressure and blood flow in the heart’s chambers. It is often coupled with coronary angiography, in which a harmless dye is injected into the coronary arties and with the help of an X-ray, blood flow through heart and blood vessels can be observed
  • Myocardial biopsy: A piece of the heart is removed and the cells are investigated for changes that may suggest hypertrophic cardiomyopathy
  • Additional tests for diagnosing the medical condition causing Acquired-HCM

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Acquired Hypertrophic Cardiomyopathy?

The following are some potential complications of Acquired Hypertrophic Cardiomyopathy:

  • Heart valve regurgitation: It causes the heart to pump ineffectively, such that blood flows back into the heart
  • Arrhythmias: Abnormal heart rhythm, which can be triggered by physical exertion
  • Sudden cardiac arrest (which can be unexpected)
  • Embolism: Development of blood clots in the heart which may get into the bloodstream and obstruct blood supply to many important organs
  • Edema: Fluid buildup in the lungs, abdomen, legs, and feet; all consequences of ineffective heart pumping
  • Individuals with the obstructive type of disease, are vulnerable to end-stage/burnt-out hypertrophic obstructive cardiomyopathy, which can result in heart failure
  • Dilated cardiomyopathy: It results from the heart muscles becoming inefficient, such that the pumping of blood is seriously compromised

How is Acquired Hypertrophic Cardiomyopathy Treated?

The treatment options for Acquired Hypertrophic Cardiomyopathy may include:

  • Lifestyle changes:
    • Adhering to a healthy diet that includes fresh fruits, vegetables, whole grains, fish and dairy products
    • Engaging in routine physical activity
    • Smoking cessation
    • Losing excess weight
    • Avoiding alcohol and illicit drugs
    • Getting enough sleep
    • Avoiding or reducing of stress
    • Seeking treatment for underlying conditions (such as diabetes, high blood pressure, etc.)
  • Beta blockers and calcium channel blockers, generally the first choice of medicines to treat cardiomyopathies, to regulate heartbeats
  • Other prescription medications may help in:
    • Regulating high blood pressure levels
    • Slow heart rate
    • Maintain normal heart beat rhythm
    • Balance electrolytes in the body; electrolytes are minerals that help in the proper functioning of muscles and nerve tissues
    • Removing excess fluid and sodium
    • Preventing blood clot formation (through anti-coagulants or blood thinners)
    • Reducing inflammation
  • Non-surgical procedures, such as alcohol septal ablation, in which:
    • Ethanol (a type of alcohol) is injected into a small artery
    • The alcohol kills cells in the tissue, to shrink the heart muscle to a more ‘normal’ size
    • This improves blood flow through the ventricles, which in turn improves the symptoms

Surgical procedures:

  • Septal myectomy:
    • It is a type of open-heart surgery that is typically used for obstructive type of hypertrophic cardiomyopathy with severe symptoms
    • The procedure is usually recommended for young patients with poor response to medicines
    • It helps in improving blood pumping by removing part of the thickened heart muscle
  • Surgically-implanted devices such as implantable cardioverter defibrillator (ICD):
    • It is a small device implanted in the chest or abdomen and connected to the heart via wires
    • The device helps control life-threatening arrhythmias that can lead to sudden cardiac arrest
  • In a small percentage of the affected individuals, heart transplantation may be necessary

How can Acquired Hypertrophic Cardiomyopathy be Prevented?

The prevention is dependent upon adequate treatment and management of chronic medical conditions that led to Acquired Hypertrophic Cardiomyopathy.

  • Regular medical screening at periodic intervals with tests and physical examinations are strongly recommended
  • Some lifestyle changes, such as following a healthy diet, quitting cigarettes, reducing alcohol drinking, getting regular exercise and reducing stress, may help prevent the severity and complications from the condition
  • In high-risk individuals, an implantable cardioverter defibrillator may help prevent sudden cardiac arrest, a potential complication of hypertrophic cardiomyopathy

What is the Prognosis of Acquired Hypertrophic Cardiomyopathy? (Outcomes/Resolutions)

The prognosis of Acquired Hypertrophic Cardiomyopathy may be determined based upon various factors including:

  • The severity of the heart condition
  • The presence of underlying or pre-existing conditions
  • A timely diagnosis
  • The commencement of treatment, and response to treatment

Appropriate treatment can help prevent worsening of Acquired-HCM, control symptoms, and reduce complications, leading to better outcomes.

  • Without treatment, the symptoms can worsen resulting in severe complications
  • In some cases, sudden cardiac arrest even at first presentation of the disease, may be fatal

Additional and Relevant Useful Information for Acquired Hypertrophic Cardiomyopathy:

Please visit our Heart & Vascular Health Center for more physician-approved health information:

http://www.dovemed.com/healthy-living/heart-center/

Was this article helpful

On the Article

Maulik P. Purohit MD MPH picture
Approved by

Maulik P. Purohit MD MPH

Assistant Medical Director, Medical Editorial Board, DoveMed Team

0 Comments

Please log in to post a comment.

Related Articles

Test Your Knowledge

Asked by users

Related Centers

Loading

Related Specialties

Loading card

Related Physicians

Related Procedures

Related Resources

Join DoveHubs

and connect with fellow professionals

Related Directories

Who we are

At DoveMed, our utmost priority is your well-being. We are an online medical resource dedicated to providing you with accurate and up-to-date information on a wide range of medical topics. But we're more than just an information hub - we genuinely care about your health journey. That's why we offer a variety of products tailored for both healthcare consumers and professionals, because we believe in empowering everyone involved in the care process.
Our mission is to create a user-friendly healthcare technology portal that helps you make better decisions about your overall health and well-being. We understand that navigating the complexities of healthcare can be overwhelming, so we strive to be a reliable and compassionate companion on your path to wellness.
As an impartial and trusted online resource, we connect healthcare seekers, physicians, and hospitals in a marketplace that promotes a higher quality, easy-to-use healthcare experience. You can trust that our content is unbiased and impartial, as it is trusted by physicians, researchers, and university professors around the globe. Importantly, we are not influenced or owned by any pharmaceutical, medical, or media companies. At DoveMed, we are a group of passionate individuals who deeply care about improving health and wellness for people everywhere. Your well-being is at the heart of everything we do.

© 2023 DoveMed. All rights reserved. It is not the intention of DoveMed to provide specific medical advice. DoveMed urges its users to consult a qualified healthcare professional for diagnosis and answers to their personal medical questions. Always call 911 (or your local emergency number) if you have a medical emergency!