Hypertrophic Cardiomyopathy and Caffeine

We all need a boost sometimes. But if you’re living with hypertrophic cardiomyopathy (HCM), you might think twice before refilling your coffee mug, steeping more tea or chugging an energy drink. After all, caffeine is a stimulant. But does that make it dangerous? v'

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The answer depends on how your body responds to caffeine — and just how much of it you’re consuming. Cardiologist Wilson Tang, MD, explains.

Is it safe to have caffeine with HCM?

While many people with HCM can tolerate moderate caffeine intake without negative side effects, others must cut it out of their diet completely.

Caffeine can be tricky with HCM because your heart is already sensitive to changes in rhythm, heart rate and blood flow. And caffeine can affect all three.

“Caffeine can increase your heart rate and stimulate your sympathetic nervous system. And both can make HCM symptoms worse,” Dr. Tang explains.

If you have obstructive HCM, caffeine can make the obstruction worse, causing increased strain and more pronounced symptoms. If you have non-obstructive HCM, the danger is that caffeine could trigger a dangerous irregular rhythm (arrhythmia).

Dr. Tang is quick to add that, while that single can of soda or cup of tea may not be problematic in some cases, not all sources of caffeine are created equal. High-dose or fast-acting products like energy drinks or caffeine pills carry more risk.

“They usually deliver large quantities of caffeine, like 200 to 400 mg at a time,” he explains. “That kind of rapid ingestion could prompt a dangerously fast increase in your blood pressure and heart rate.”

How much can you have?

There’s no universal rule about how much caffeine people with HCM can consume in a day. But for most, Dr. Tang says one to two regular cups of coffee a day (200 to 300 milligrams of caffeine) is reasonably safe. Just pay close attention to how your body responds.

And make sure you know how much caffeine you’re getting: A cup of coffee can have as few as 95 mg of caffeine, but some brews contain a whopping 500 mg!

Experts recommend that most people limit their caffeine to 400 mg a day. If you have HCM, you may need to stay below that. Your best bet? Ask your provider. Their answer will take the severity of your condition into account.

The key, Dr. Tang says, is common sense and moderation. If that first or second can of soda is making you jittery or giving you palpitations, that’s a clear sign you need to cut back. If you don’t feel like you can — because of fatigue, brain fog or difficulty concentrating — that’s worth investigating.

“If you find yourself needing many cups of coffee, you need to talk to a cardiologist,” he stresses. “They need to make sure your HCM isn’t getting worse — or if it is, that you’re getting proper treatment.”

Caffeine and HCM symptom monitoring

“Generally, caffeine intake is safe, but only to a point,” Dr. Tang reiterates. “The key is knowing your personal limits and recognizing when it causes symptoms.”

How do you do that? Dr. Tang recommends symptom journaling. It’s a simple way to see how your body reacts to caffeine. It can also help you identify habits, patterns and triggers you might not otherwise notice.

To start, track the following:

Caffeine consumption: Note how much caffeine you’re taking in, in what form and when.
Triggers: Did you pour that tall glass of iced tea out of habit, because you were tired, to get through a frustrating meeting or for another reason?
Symptoms: Record any physical, mental or emotional changes you experience.
Timing: Document when and what symptoms you experience throughout the day.
Energy levels: Log any fluctuations in your energy.

You can use a notebook or a tracking app to keep your data organized. As you compile these records, consider sharing them with your cardiologist. The information you collect can help them better advise you.

For your symptom journal to be useful, track every source of caffeine you consume. But that can be easier said than done.

Sneaky sources of caffeine

Coffee, tea, soda and energy drinks are the usual suspects of the caffeine world — but they aren’t the only players you need to be aware of. You could also be taking in caffeine when you have certain kinds of:

Chocolates
Certain types or blends of herbal tea
Protein powders or drinks
Weight loss or fitness supplements
Medications, like OTC migraine pills
Caffeinated water beverages
Chewing gums
Energy bars
Coffee or mocha flavored treats (like ice cream)

Believe it or not, there’s even caffeine in decaf coffee! And while a few mg here and there doesn’t seem like much, it can add up fast. So, be mindful about all the different types of caffeine you consume each day, and the cumulative effect they have on your health.

What to do if you drink too much caffeine

Most people experience unpleasant symptoms when they indulge in one (or three) too many cups of coffee. But if you have HCM, they could be a sign of trouble.

“Too much caffeine can exacerbate hypertrophic cardiomyopathy and trigger dangerous heart-related symptoms,” Dr. Tang explains.

If you notice that you’re having palpitations or other cardiac symptoms, try to stay calm.

“First, stop and rest,” he advises. “Then, hydrate and monitor your symptoms. That’s often enough. If the symptoms don’t get better, then we’d worry that the caffeine either made the obstruction worse or pushed your heart into an unsafe rhythm.”

Dr. Tang also advises you to seek medical attention immediately if you:

Have palpitations that don’t go away with rest
Are experiencing chest pain or discomfort
Feel lightheaded, dizzy or like you may faint
Have shortness of breath that doesn’t improve with rest
Feel like your heart rhythm “won’t reset”

When to get help

If you find it hard to function without caffeine, Dr. Tang recommends seeing your cardiologist. Fatigue can be a sign that your condition is getting worse.

“If you’re drinking four or five cups of coffee a day, we need to ask why you’re doing that,” he explains. “It could be a clue that there’s a deeper problem.”

Even if you’re doing OK, the best way to avoid a caffeine-induced HCM flare is to reduce or eliminate it from your daily routine. If you do decide to scale back or quit, it’s best to do it gradually. That way, you’re less likely to deal with withdrawal symptoms, like headache, fatigue or irritability.

Getting enough sleep, exercising, staying hydrated and making clever substitutions are just a few ways to reduce your reliance on caffeine. Working with your doctor is another good move. It isn’t always easy to break the habit, but the peace of mind — and benefit to your heart health — is well worth it.