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Hypertrophic Cardiomyopathy Center

HCM Treatment Options

Drug treatments and medications

Many HCM patients successfully control their symptoms for years—even decades—solely with medication. Some of our most commonly prescribed HCM medications include: 

  • Beta blockers (controls symptoms)
  • Calcium channel blockers (controls symptoms)
  • Disopyramide (controls symptoms in some obstructive HCM patients)
  • Antiarrhythmic drugs (manages atrial fibrillation)
  • Anticoagulants (manages atrial fibrillation) 

In some obstructive HCM patients, if symptoms worsen or become difficult to control, we may recommend more advanced treatment options, including: 

  • Surgical Septal Myectomy (see below)
  • Alcohol Septal Ablation (see below)

Role of CardioVascular Imaging Center in planning

The CardioVascular Imaging Center at Tufts MC is intimately involved in every myectomy—in pre-planning, in the operating room during surgery, and in follow-up—to assure the effectiveness and safety of operation. 

Invasive treatment options

Most obstructive HCM patients remain asymptomatic for life or have symptoms well-controlled with appropriate medication. However, when symptoms persist or medication causes troublesome side effects, several excellent options exist to eliminate obstruction and improve symptoms.

  • Surgical Septal Myectomy

Septal myectomy surgically reduces the thickening of your heart muscle. Following a chest incision, your heart is stopped and a bypass machine takes over the work of your heart and lungs. Through a subsequent incision in your lower aorta, a portion of your septal wall is thinned via resection, or surgical removal, thereby eliminating any blood flow obstruction. Your heart’s pressures return to normal, and your HCM symptoms are dramatically improved or eliminated. The average hospital stay for this procedure is five days, after which most patients go home for a six- to eight-week recovery period before returning to a normal routine.

A small number of patients require surgery (find out more about surgical septal myectomy), but if it is necessary, our HCM Center has one of the most experienced and effective surgical programs to relieve obstruction and symptoms in HCM patients. Over the last 15 years, Hassan Rastegar, MD, has successfully operated on 7,500 people, and more than 90% of his patients return to a normal lifestyle.

Is there an alternative to myectomy?

Yes. If you do not quality for (or do not want) surgery, alcohol septal ablation is a reasonable and effective alternative. Carey Kimmelstiel, MD has effectively performed more than 100 alcohol ablations.

  • Alcohol Septal Ablation

Alcohol septal ablation is a minimally invasive catheter-based procedure to reduce the thickening of your heart muscle. Through a small incision at the top of your leg, a catheter is inserted into your femoral artery and advanced to your heart’s septal artery. After a tiny balloon at the tip of the catheter inflates to block blood flow, one to two milliliters of 100% ethyl alcohol flows through the catheter into your septal artery. The alcohol causes small, controlled heart damage, which—after the surgery and over the course of several weeks to months—reduces the thickness of the septum, eliminating blood flow obstruction, restoring your heart’s pressures to normal, and resulting in a significant improvement or elimination of heart failure symptoms. The average stay in the hospital for this procedure is four days, after which most patients go home to a seven- to ten-day recovery period before returning to a normal routine.

    Sudden death is preventable

    The HCM Center works to identify high-risk young patients and prevent sudden death due to arrhythmias with the implantable defibrillator (ICD), which automatically reverses potential lethal arrhythmias.

    Implantable cardioverter defibrillator (ICD)

    An image of a cardiac pacemaker at Tufts Medical Center's HCM Center in downtown Boston, MA.

    HCM patients at high risk for sudden death may be candidates for an implanted cardioverter defibrillator or ICD: a sophisticated device permanently inserted under the skin, capable of sensing potentially lethal arrhythmias and automatically terminating them by shocking to return a normal rhythm. Only a very small percentage of HCM patients are at increased risk for these arrhythmias. 

    Over the years, the ICD device has become smaller and easier to implant, currently requiring only an overnight stay in the hospital. The traditional transvenous ICD is implanted just under the collar bone, with lead wires introduced to the heart chambers through the veins. The newer subcutaneous ICD sits adjacent to the left rib cage with leads just under the skin and requires no wires. Both devices have potential benefits which our team will discuss with you in detail should an ICD need arise.
Two surgeons performing a complex procedure called an alcohol ablation at Tufts Medical Center in Boston.

We have your best interest at heart

Welcome to the Tufts Medical Center HCM Center. Click here to meet our team, learn about our approach, and find out why we’re an HCM Center of Excellence.

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Sue Costa is the coordinator in the Hypertrophic Cardiomyopathy Center at Tufts Medical Center in downtown Boston, MA.

For an appointment, contact our HCM Center Coordinator Sue Costa.

Phone: 866-972-3678
Email: scosta2@tuftsmedicalcenter.org

Father, son Cardiovascular Specialists, Barry and Martin Maron, spread the word that HCM is now a manageable disease at Tufts Medical Center in downtown Boston, MA.

The father-son duo that’s changing a cardiac narrative

Drs. Barry and Marty Maron want you to know something: HCM is now a treatable disease compatible with normal longevity and a good quality of life.

Read the article