Why Hypertrophic Cardiomyopathy Symptoms Can Change From Day to Day and Over Time

When living with hypertrophic cardiomyopathy (HCM), or a thickening of the heart muscle, it can be hard to predict how you’ll feel on any given day. Symptoms like shortness of breath, dizziness or fatigue may seem to pop up out of nowhere. This can be confusing, scary or just plain frustrating.

If you’re trying to make sense of it all, you’re not alone.

Cardiologist Milind Desai, MD, sheds some light on why symptoms can change from day to day and over the years — and how you can manage them.

Why HCM symptoms come and go

There’s a rhyme and reason to when your HCM symptoms appear.

“Symptoms happen when blood isn’t flowing normally through your heart and out to your body,” Dr. Desai explains. “If enough blood can’t reach your brain, you’ll feel dizzy or faint. If blood backs up in your lung arteries, you’ll feel short of breath.”

So, what keeps blood from moving as it should? Most people with HCM have something called an obstruction in their heart. This narrows the path where blood can flow out of their left ventricle, the heart’s main pumping chamber.

But here’s the tricky part: These obstructions are dynamic. That means they limit blood flow just some of the time, typically when your body’s demand for blood goes up.

When you’re relaxing in a climate-controlled room, you’ll probably feel fine. But if you’re lugging grocery bags or gardening in the sun, your heart works harder and beats faster to meet your body’s needs. That’s when you might start to feel the effects.

Triggers can change throughout the day

HCM affects everyone a little differently. But in general, you’re more likely to experience symptoms when you’re:

• Dehydrated: Your heart has to work harder if you’re dehydrated. This lowers your blood pressure and can quickly make you feel dizzy or even faint.
• Stressed: When emotions run high, so does your heart rate — and that’s a recipe for HCM symptoms. And once you start feeling unwell, your stress level might go up even more. It can be a vicious cycle.
• Exerting yourself: Whether you’re helping your friend move furniture or carrying a stubborn toddler through the mall, your heart works harder. “Actions that require bearing down, like heavy lifting, may trigger symptoms,” Dr. Desai notes.
• Eating a heavy meal: When you have a big meal, more blood goes to your digestive system to help it break down nutrients. This creates more work for your heart and reduces the amount of blood available to nourish your heart muscle.
• Drinking alcohol: Alcohol serves up a double whammy when it comes to HCM symptoms. It acts as a diuretic, which can dehydrate you. Plus, it’s a stimulant that raises your heart rate.
• In extreme temperatures: Hot, humid weather, as well as frigid temps, can raise your heart rate and trigger symptoms — especially if you’re exerting yourself.
• At high altitudes: Low oxygen levels at high altitudes stress your heart and cause it to beat faster. This can lead to HCM symptoms.

The disease (and symptoms) change as you age

HCM isn’t a static condition. It changes right along with your body as you age.

“You might go many years without any symptoms, but then develop them as you get older,” Dr. Desai says. “Your heart may grow stiffer or thicker, or scar tissue may develop. All these things can aggravate symptoms and affect how you feel.”

It’s also possible to start off with non-obstructive HCM, but then develop obstruction over the years. This is partly because, as you get older, your aorta leaves your heart at a sharper angle than it did when you were younger. This can make it harder for enough blood to leave your heart and get out to your body.

“Blood is forced to take a sharp turn as it leaves your heart,” Dr. Desai illustrates. “It’s like taking a hard turn at an intersection instead of going straight.”

Besides changes to your anatomy, aging also brings an increased risk for issues like coronary artery blockages or abnormal heart rhythms.

“Simply put, aging adds fuel to the fire,” he adds.

It’s important to tell your cardiologist about any changes you notice as soon as possible. They can adjust your treatment plan to help you feel better and lower the risk of complications.

Tips for symptom management

HCM symptoms don’t have to define your life. Thanks to advances in treatment, you may be able to minimize symptoms and lower your risk for complications. The key is regularly seeing your cardiologist and sticking with your care plan.

It’s also important to do whatever you can to avoid symptom triggers. That might include avoiding alcohol, eating smaller meals and finding ways to manage stress. Dr. Desai suggests talking with your cardiologist to get self-care advice tailored to your needs.

“With proper management, you can have HCM but not even notice it from day to day,” he continues. “Symptoms can be minimal or, in some cases, go away completely.”

Even better news? Treatment can help you live just as long as those without HCM.

“It’s already a great time to be living with HCM,” Dr. Desai says. “But we’re continually learning and developing more effective therapies that can help you feel better and live longer — and we’re not done yet.”