What are the Symptoms of Hypertrophic Cardiomyopathy?

Shortness of breath Exercise capacity may be limited by shortness of breath and fatigue (also called dyspnea). Most individuals experience only mild limitation of exercise, but occasionally this becomes severe and patients are unable to walk even one city block or a flight of stairs without stopping due to shortness of breath; a small minority may have shortness of breath at rest.

• Chest pain Chest pain or pressure (sometimes called angina) is a common symptom. It is usually brought on by exertion or meals and relieved by rest, but may also occur at rest. In HCM, chest discomfort may also take different forms--sharp or dull, in the center of the chest or elsewhere, or prolonged and unrelated to exertion. The cause of the pain is thought to be insufficient oxygen supply to the heart muscle. In HCM, the main coronary arteries are usually free of significant plaque or narrowing from atherosclerosis. However, in contrast, the smaller arteries within the heart muscle are often narrowed; the greatly thickened left ventricular muscle demands an increased oxygen supply that often cannot be served by the abnormal small arteries.

• Fatigue A complaint distinctive from shortness of breath with exertion; many patients complain of excessive tiredness, either related or unrelated to exertion.

• Palpitations Patients may occasionally feel an extra or skipped beat, and this may be normal. Sometimes, however, such an awareness of the beating heart is indicative of an irregular heart rhythm. This symptom, palpitations, may also occur commonly in other forms of heart disease, and even in many normal people. Palpitations begin suddenly, and may be associated with symptoms such as sweating or lightheadedness. Such episodes should be reported to the cardiologist for further investigation.

• Lightheadedness and fainting Patients with HCM may experience impairment or loss of consciousness, i.e., lightheadedness or dizziness, and, more seriously, fainting (known as syncope). Such episodes may occur in association with exercise, or without apparent provocation, and the reason for these events is not always clear, even after testing. Impaired consciousness may be due to an irregularity of the heartbeat, a fall in blood pressure; very uncommonly, it is unrelated to HCM and heart disease, and is termed "simple faint" or vasovagal syncope, in which the vagas nerve is excessively active. Fainting (or near-fainting) should be reported immediately to the cardiologist and investigated. Unfortunately, such episodes represent the most difficult HCM symptom to evaluate, simply because the events occur without warning, and are usually long over before your physician can order tests to investigate their origin.