Obstructive Hypertrophic Cardiomyopathy or Medication? How to Tell When Symptoms Need Attention

If you have obstructive hypertrophic cardiomyopathy (oHCM), an onset of new symptoms can raise an unsettling question: Is the condition getting worse?

While it’s certainly possible for obstructive hypertrophic cardiomyopathy to progress, there’s another possible explanation for a new bout of symptoms: Medication could be causing unwanted side effects, including dizziness, fatigue, and shortness of breath.

It can be tricky to know which one is to blame, partly because the symptoms of obstructive hypertrophic cardiomyopathy and the medication side effects can look a lot alike. Moreover, “Sometimes there’s an overlap between both of those,” says Jessica Lauren Atkins, MD, a cardiologist specializing in hypertrophic cardiomyopathy at Medical University of South Carolina Health in Charleston.

Use this guide to find out what’s behind the symptoms and whether treatment may need to change.

• A slower-than-usual resting heart rate
  
• Cold hands and feet
• Dizziness or lightheadedness, especially when standing up quickly
• Mild fatigue that isn’t related to physical activity
• A sluggish or unusually tired feeling

• Arrhythmia (abnormal heart rhythm)
• Chest pain, pressure, or tightness
• Dizziness or feeling faint during activity
• Fainting, particularly with exertion
• A noticeable drop in your stamina or ability to exercise
• Shortness of breath when walking, exercising, or climbing stairs

Pay particular attention to symptoms that persist or get worse. “Anything that is not getting better is something that we should pay attention to,” says Dr. Atkins.

Think about what has changed in your daily life. Maybe you used to walk up the stairs without stopping, but now you need a break. Maybe you’re taking the elevator more often. Or maybe you’re not walking much at all anymore, because you’re short of breath.

“Any change in ability that you’ve had — something you can’t do as frequently or as easily — then we should reevaluate [you],” says Atkins.

It can be easy to write off fatigue as a normal part of having obstructive hypertrophic cardiomyopathy or an unavoidable part of taking medication for it. But any new or worsening symptom is worth mentioning to your doctor.

Depending on symptoms, the degree of obstruction, and test results, your cardiologist may adjust the current medication or consider other treatment options. These may include beta-blockers or nondihydropyridine calcium channel blockers, such as verapamil (Calan, Verelan) or diltiazem (Cardizem, Cartia XT). If you continue to have symptoms on one of these medications, options may include a cardiac myosin inhibitor or disopyramide (Norpace).

Your doctor can help you determine whether symptoms may be caused by a medication or from the obstructive hypertrophic cardiomyopathy istelf. At your next appointment, be specific about what you’ve noticed. You might ask:

• Could this symptom be a side effect of medication or related to obstructive hypertrophic cardiomyopathy?
• I’ve noticed I can’t do       as easily. Could that be related to the obstructive hypertrophic cardiomyopathy?
• Is the current medication and dose still right for me?
• Are there symptoms that should prompt me to contact you sooner?

You can also consider keeping a short symptom diary before your appointment, says Atkins. For about two weeks, jot down what you’re feeling, what you were doing when it happened/whether you were resting or active, and when you took medication. You may notice patterns that are easy to miss day-to-day.

Most important, don’t stop or change medication on your own. If something doesn’t feel right, tell your care team. That conversation can help them determine what’s behind the symptoms and whether treatment needs to be adjusted.