Hypertrophic cardiomyopathy (HCM) is a condition characterized by thickening of heart muscle not secondary to a known underlying cause, such as hypertension or valvular heart disease. HCM runs in families, and over one thousand different mutations on several different genes have been identified.
An overview of HCM
There are different subtypes of HCM and only part of the heart may be involved. For example, in asymmetric septal hypertrophy, the major abnormality is thickening of the heart muscle that separates the left ventricle from the right ventricle.
HCM can present from early childhood through old age. It is usually diagnosed by echocardiography or cardiac magnetic resonance imaging (MRI). Abnormalities on electrocardiography (EKG) are often present.
Although some people with HCM may be asymptomatic, serious complications can include sudden cardiac death from ventricular arrhythmias, heart failure, mitral regurgitation and atrial fibrillation. Shortness of breath, syncope, chest discomfort, and palpitations may be experienced.
Some people with HCM experience what is called left ventricular outflow tract obstruction, which means that blood flow from the left ventricle to the rest of the body is partially blocked. This can result in a worse prognosis. When present, the obstruction can vary with day to day activities and may increase with exercise.
Treatments might be necessary for people with HCM if symptoms or complications are present, and might include medications, surgical procedures, or perhaps placement of an implantable cardioverter defibrillator (ICD).
Underwriting Hypertrophic Cardiomyopathy
The underwriting of HCM can be challenging. The underwriter needs to assess the risk of sudden cardiac death, which is increased if there is a history of syncope, previous cardiac arrest or serious arrhythmias, a family history of sudden cardiac death, left ventricular outflow tract obstruction, and significant thickening of heart muscle.
Applicant 1 is a 60 year old with no significant medical history who had a recent echocardiogram due to a murmur on examination. The echocardiogram revealed asymmetric septal hypertrophy, with mild thickening of the heart muscle between the left and right ventricle, with no left ventricular outflow tract obstruction. The applicant has no complaints, a normal electrocardiogram, and both parents are alive and well. Based upon the applicant’s age, mild amount of heart muscle thickening, and absence of risk factors for sudden cardiac death, this case can be Standard Plus.
Applicant 2 is a 30 year old who is being evaluated for two recent syncope episodes. The applicant’s brother and father both died suddenly. An electrocardiogram showed major changes and an echocardiogram revealed hypertrophic cardiomyopathy with severe thickening of the heart muscle and significant left ventricular outflow tract obstruction. Due to the history of syncope, family history of sudden death, electrocardiogram changes, extent of heart muscle thickening, and significant left ventricular outflow tract obstruction, this case is a decline.
Applicant 3 is a 55 year old being followed for a history of hypertrophic cardiomyopathy. A recent echocardiogram showed moderate thickening of the heart muscle. The applicant’s father had sudden death and the family history is otherwise favorable. An electrocardiogram shows minor changes. There is no significant left ventricular outflow tract obstruction. This case can be Three Tables.