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Forum Name: Cardiomyopathy

Question: Hypertrophic Cardiomyopathy


 Kisa87 - Fri May 01, 2009 8:17 pm

Hi my name is Nicole and I have some questions about HCM. Can HCM be missed or looked over on an echocardiogram, if the technician is not specifically looking for it? Or is it a condition that would be obvious and call attention to itself on an echo image? Also would abnormailites show up on an EKG if this condition was present? I have been diagnosed with inappropriate sinus tachycardia and mild mitral valve prolapse along with panic attacks and I was told these things can mimic HCM, especially the pains and shortness of breath/exercise intolerance associated with IST and MVP.
I was in the ER today because of a HR of 170, which went down in the ambulance to 112, then back up to 170 then slowly back down to normal. I also have been experiencing mild chest pains on my left side that come and go over the past few days. They have a burning and tight feel to them. I am currently taking toprol 50 mg a day. The ER doctor dismissed this as chest wall pain due to palpitations. Is this reasonable to assume? Should I get a second echocardiogram just to be safe? I felt like i wasn't taken very seriously. Thank you for your time.
 John Kenyon, CNA - Tue May 12, 2009 10:05 pm

User avatar Hi Nicole --

Thanks for an intelligent question and for bringing your concerns here. While it is possible for very HCM to be overlooked, it is almost never actually missed, because the measurements of the structures and the chambers will tell the story, whether it is slight or pronounced. It is a very clear phenomenon and diagnosis is based upon those measurements. Now then: the symptoms of HCM are partially as you interpret them, but there's more to it than that. For one thing, exercise intolerance is often not seen with HCM, except after the fact. Many athletes have this problem (an exaggeration of "athlete's heart") and are able to perform at amazing levels. It is the cool down period where trouble starts, and it can be profound. Also, rapid heart rate is not a hallmark of HCM, while it is usually seen with both MVP and panic disorder, which also tend to go hand-in-hand. So not only do you not have an echocardiographic confirmation of HCM but you don't have the symptology associated with it. The pain in your left chest,while no doubt chest wall inflammation-caused, is not due to palpitations, but due to some inflammatory process, quite possibly due to faulty breathing patterns which are often seen in people with anxiety/panic problems and, of course, MVP. The pain associated with HCM is different, and occurs either on initial exertion or post exercise. It's just a whole different animal. I'm telling you all these trivialities simply to hopefully convince you there's no reason (including family history, which is also often a factor in HCM) to even remotely suspect you have this more serious problem. However, you have heard of it (or you wouldn't have wondered about it) and it's natural, especailly among inteligent but anxious people, to worry about these possibilities. I'm here to tell you it's already been ruled out. In order to have symptoms you'd at the very least have to have measurable (and significant) echocardiographic evidence. It's not there. Be glad. You've got your hands full with MVP. Oh, also yes, there would be distinctve EKG changes peculiar to HCM. There are changes often with MVP, too,but they are not distinctive and are very nonspecific when seen at all. Just one more avenue by which you can rule out HCM. It's not there.
I hope this is helpful. I know how difficult it can be to separate out the possible from the proven, especially with given the special focus on these things brought out by anxiety. Trust me on this.

Good luck to you, and if I've left any loose ends hanging out, don't hesitate to ask about them, or at least point them out. My interest is in preventing your from becoming burdened with a concern you don't need to deal with. I know how scary these things can be. Again, trust me on that.

Good luck to you and really, please do follow up with us here as needed. This is important to me, because I want you (and everyone who crosses my path here) to enjoy the best possible quality of life. MVP is enough of a challenge, even though it's essentially benign and harmless. Good luck to you and please do stay in touch.
 Kisa87 - Tue Jun 02, 2009 11:13 am

Thank you for such a reassuring and informative reply. I know it's just the nature of anxiety to pick one of the worst things you could have and then fixate on it. I do realize that with no family history of HCM and a clean echo that this is obviously not what I have. Thanks again!
 Kisa87 - Mon Oct 05, 2009 9:12 pm

Hello,
I had a follow up question. On my echocardiogram, it is stated that Left Ventricle:...." The Doppler derived early diastolic deceleration time is prolonged at 268 msec" It then says the overall diastolic pattern is one of normal relaxation and filling pressures. What does the prolonged deceleration time mean and is it significant? Thanks so much
Nicole

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