Triggers That Can Worsen Obstructive Hypertrophic Cardiomyopathy Symptoms

If you’re living with obstructive hypertrophic cardiomyopathy (HCM), you might find yourself wondering when symptoms will strike next. It’s not always easy to predict episodes of fatigue, trouble breathing, dizziness or fainting. And the symptoms you feel may change based on what you’re doing at the moment.

But over time, you may start to notice patterns. That’s because certain triggers are known to worsen symptoms for many people with this disease. When those same triggers keep popping up, you’ll keep feeling the effects.

Cardiologist Ben Alencherry, MD, explains why obstructive HCM causes symptoms, sheds light on common triggers and offers advice for feeling better.

Why obstruction causes symptoms

The key feature of obstructive HCM, which sets it apart from its nonobstructive counterpart, is a thickening of your heart muscle as it approaches your aortic valve. Blood flows through this area on its way out of your heart.

“When the muscle there is too thick, it forms an obstruction that reduces blood flow out of your heart,” Dr. Alencherry explains. But the obstruction can get worse at certain times. And that’s when symptoms will be most noticeable.

Symptom triggers

Triggers can include anything that makes your heart beat faster or stronger, or that makes you have some level of dehydration.

“This makes it harder for blood to leave your heart and feed your organs, and you may feel symptoms as a result,” Dr. Alencherry says.

He walks us through some of the most common symptom triggers.

Alcohol intake

Alcohol can trigger HCM symptoms in a couple ways:

• It raises your heart rate, which forces your heart to work harder.
• It makes you go to the bathroom more often, which can quickly lead to dehydration.

“Alcohol intake is one of the most common triggers of HCM symptoms,” Dr. Alencherry shares. “When you drink, you may notice you feel terrible afterward. Your breathing might get worse, and you might feel fatigued. That’s because the alcohol is making your heart work harder to keep blood moving through your body.”

If possible, avoid alcohol altogether. That’s best for your heart. And if you choose to drink, have no more than one.

Substance use

Besides alcohol, other addictive substances can also trigger HCM symptoms. Especially concerning are stimulants, like cocaine, that get your heart rate dangerously high.

“Recreational drug use can have harmful effects on anyone’s heart, but it may have a more pronounced impact on someone with HCM,” Dr. Alencherry stresses. “I strongly recommend avoiding cocaine and all recreational drugs.”

Medications

Certain medications, like nitrates and diuretics, may worsen the obstruction in your heart. It’s important to talk to your cardiologist about which meds you should avoid or use with caution.

Also, stay alert to any drug that has side effects like diarrhea or appetite loss, which can lead to dehydration. “That’s the case with new GLP-1 medications,” Dr. Alencherry points out. “You should be very careful before starting these medications if you have obstructive HCM. Talk to a cardiologist first.”

Sleep disturbances

If you’re not getting enough quality sleep, your heart rate tends to go up. And, you guessed it, that increases your heart’s workload and worsens the obstruction.

But it’s not just the lack of shut-eye that’s a problem. It’s what you do to compensate.

“When you don’t sleep well, you may load up on caffeine to get through the day,” Dr. Alencherry says. “And while it’ll perk you up, it’ll also raise your heart rate.”

Caffeine also acts as a diuretic, so there’s a double whammy effect when it comes to triggering HCM symptoms.

Does that mean you should never enjoy a morning cup of joe? Dr. Alencherry says completely avoiding it may be unrealistic. But try to:

• Limit caffeine as much as possible, including from sources like coffee, tea, energy bars and chocolate.
• Find ways to improve your sleep hygiene, like limiting screen time before bed and creating a consistent sleep-wake schedule. This can help you rely less on caffeine.

Being sick

Getting sick is never fun. But with HCM, the same bug that’s a minor annoyance for others can cause extra misery for you. That’s because:

• Diarrhea or vomiting can lead to dehydration, worsening your HCM symptoms.
• A fever, which makes your body sweat a lot, can also lead to dehydration.

When you’re sick, make hydration a priority and talk to a healthcare provider if you feel you’re losing more fluids than you’re taking in.

Inadequate water intake

Even on an ordinary day when you’re feeling good, think about how much water you drink. Not sure? Don’t keep track? You’re not alone. But when you have HCM, it’s important to start measuring those ounces.

“Many people, especially young adults, don’t track their water intake,” Dr. Alencherry observes. “But I always push for staying hydrated. Even when you’re not thirsty, you should drink up. You must stay one step ahead of dehydration.”

Talk to your healthcare provider about the daily target that’s right for you.

Large meals

Eating a big meal, especially one high in carbs (like pasta or bread), may trigger HCM symptoms. Having several smaller meals, spaced throughout the day, may help you avoid this issue.

When you eat a lot at once, more blood must go to your digestive organs. That means your heart muscle receives slightly less blood flow than usual. And that’s just enough to worsen the obstruction and bring on symptoms.

Stress

When you’re stressed out, your body reacts in lots of ways — including by raising your heart rate. That pounding sensation in your chest means your heart is working overtime. And you may start to feel unwell as a result.

It’s not always possible to avoid stress. But finding healthy ways to relieve it, like spending time in nature or listening to music, can help you protect your heart and feel better.

Heat

Hot, humid weather raises your heart rate, which can bring on HCM symptoms. If you’re exerting yourself, that’ll make matters even worse.

“It’s also important to think about other scenarios where your body can get overheated,” Dr. Alencherry says. “Hot environments like a sauna or bath also get your heart pumping faster, which can quickly lead to symptoms.”

It can help to:

• Add warm (not hot) water to the tub when you want a soak.
• Limit your time in a sauna to just a few minutes.
• Take plenty of breaks in a cool, shaded space when you’re out in the sun or heat.

Final thoughts

Learning what triggers your HCM symptoms is the first step toward finding relief. That’s because you can take steps to avoid those triggers as much as possible.

“It may help to keep a symptoms log,” Dr. Alencherry advises. Write down:

• The symptoms you felt
• What was happening when they started
• How long they lasted
• The date and time

You can share this information with your cardiologist and identify patterns. But medication may play an important role in managing obstructive HCM symptoms, too.

“Thankfully, we have newer medications that can relieve the obstruction in your heart and stop symptoms from happening,” Dr. Alencherry says.

Your cardiologist will work with you to develop a treatment plan that meets your needs. Be sure to tell them if you have new or worsening symptoms.

“Obstructive HCM doesn’t have to keep you from enjoying life,” Dr. Alencherry reassures. “With a little awareness of your triggers, and some teamwork with your cardiologist, you can start feeling better and shifting your focus to the things you care about most.”