New guidelines for clinicians in the treatment of hypertrophic cardiomyopathy (HCM) now offer updated standards of practice, especially beneficial for athletes and recreational sports enthusiasts.
HCM is a genetic cardiovascular disease characterized by a hypertrophied, nondilated left ventricle (LV) in the absence of other causes. It is relatively common and is one of the most frequent causes of sudden death in athletes.
Matthew Martinez, MD, director of Atlantic Health System Sports Cardiology and Director of the Hypertrophic Cardiomyopathy Program at Morristown Medical Center, and a nationally recognized expert in Hypertrophic Cardiomyopathy (HCM), was an author of the 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines, which appeared in the May 8 edition of Circulation, the journal of the American Heart Association.
“HCM guidelines are usually updated every four years. Since the last guidelines came out in 2020, there has been an enormous amount of data in the management of hypertrophic cardiomyopathy, especially in regard to exercise recommendations and the management of the condition in athletes,” said Dr. Martinez. “We can now provide better overall care to this patient group because of our increased knowledge of effective medications and overall health benefits for our patients.”
The article addresses a new class of medications, myosin inhibitors, that are being used effectively for HCM. The inhibitors reversibly interact with myosin chains to reduce the number of interactions, which aids in reducing the pumping function of the heart that can lead to heart failure, and allows for increased exercise tolerance. It achieves its therapeutic effect by reducing hypercontractility and improving diastolic function in obstructive HCM.
“Myosin inhibitors are now considered a front-line therapy for those patients who do not tolerate beta or channel blockers, or as an add-on medication,” explained Dr. Martinez. “Patients feel better, have less breathlessness and have an easier time exercising.
However, in some cases, the use of this medication can cause the pumping function to weaken so routine echocardiograms are necessary to monitor the left ventricular function of the heart, and if necessary, medications can be adjusted.
Traditionally, said Dr. Martinez, there has been some complexities in determining the amount of exercise recommended for those with HCM. “There have been mixed messages about playing sports and exercise, but we now understand that for overall health, exercise is important and physicians should make this be part of their discussions with patients. Previously, those with HCM were not encouraged to play collegiate level or professional sports, but those guidelines have changed.”
Dr. Martinez added, “We now know that those who are fit do better health wise. Being active, along with a healthy diet and medication, can help improve the overall care of patients with HCM.”