Tag: heart health

In June of 2022, a report from the American Diabetes Association highlighted heart failure as “an underappreciated complication of diabetes.” According to that report, up to 22% of people with diabetes will develop heart failure, and the incidence of heart failure within the diabetes community is increasing.

“Heart failure is the most prevalent cardiovascular complication in people with diabetes,” says Dr. Rodica Pop-Busui, a professor of diabetes at the University of Michigan and president of medicine and science at the American Diabetes Association. “In the U.S. alone there are 37 million people diagnosed with diabetes, and heart failure in this population is a very serious health care problem that needs to be addressed before it reaches more advanced and more costly stages.” 

For a time, it was thought that heart failure might mainly affect people with Type 2 diabetes. But the latest research suggests that people with Type 1 diabetes are also at risk. “When you look at all people with diabetes, either Type 1 or Type 2, the incidence of heart failure is four times higher than it is in the general population,” says Dr. Amgad Makaryus, a professor of cardiology at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in New York.

The term “heart failure” refers to problems with the heart muscle’s ability to pump blood. These problems can deprive other parts of the body of sufficient oxygen and blood. They can also cause fluid buildup in the lungs, abdomen, and limbs. Heart failure can produce a wide range of symptoms, and it can also lead to organ damage or sudden death. Heart failure is not only more common in people with diabetes than in the general population, but it may be more deadly. A study of more than 36,000 people in the European Journal of Heart Failure found that median survival was reduced by more than a year among those who had both heart failure and Type 2 diabetes compared to those with heart failure alone. 

Here, experts explain the connection between the two medical conditions. They detail the heart failure signs and symptoms to watch out for if you have diabetes, and the best available courses of treatment. They also offer advice for people with diabetes who want to lower their risks for heart failure.

The connection between heart failure and diabetes

Among people with diabetes, glucose (also known as blood sugar) does not move out of the blood and into the cells the way it should. This leads to elevations of both blood glucose and insulin, which is a hormone that helps clear the blood of glucose. These elevations may contribute to the development of heart failure in some people with diabetes. “Elevations in glucose levels and elevations in insulin levels can cause damage at a molecular level to cells of the heart,” Makaryus says. 

But that’s far from the only connection between the two conditions. “Mechanistically, there are several processes that affect people with diabetes that raise their risk for heart failure,” says Dr. James Januzzi, a professor of medicine at Harvard Medical School and a clinical cardiologist at Massachusetts General Hospital. Januzzi says that, besides increasing risk for coronary artery disease, diabetes can cause direct injury to the heart muscle, resulting in stiffening and weakening that can culminate in heart failure. Research has linked diabetes to mitochondrial dysfunction, oxidative stress, inflammation, and an increase in the formation of harmful compounds called advanced glycation end products, or AGEs—all of which can contribute to the development of heart failure. “Diabetes is associated with a shift from glucose-related metabolism in the heart to the production of the sugar alcohol sorbitol, which may lead to cell death with scarring of the heart muscle,” Januzzi explains. “We also know that individuals with diabetes are at higher risk for chronic kidney disease, which is an independent risk factor for heart failure.” For all of these reasons, he says that the mere presence of diabetes is now considered a primary risk factor for heart failure.

Read More: How Stress Affects Your Heart Health

Signs and symptoms of heart failure

The symptoms of heart failure tend to be the same whether or not a person has diabetes. Fatigue lands at or near the top of the list, although at first this symptom may be subtle. “Someone may just feel like they don’t have the same energy they used to,” Januzzi says. Shortness of breath is another cardinal symptom of heart failure, but this may be difficult to spot if a person’s fatigue has caused them to cut down on physical activity. “Frequently I’ll ask a patient if they get shortness of breath and they’ll say no, but it’s because they’ve reduced their activity,” he says. As heart failure progresses, these symptoms tend to become much more noticeable. For example, shortness of breath can show up even after very mild physical activity, such as walking up a few stairs.  

“Another classic sign is not just shortness of breath when you exercise, but shortness of breath when you’re lying down, or that wakes you from sleep,” says Makaryus. “This has to do with fluid overload in the lungs as a result of the heart not pumping the way it should.” Fluid overload can also lead to swelling (or edema) in the legs or abdomen of people with heart failure, he says.

While those are the most common symptoms, others include wheezing, weakness, a rapid or irregular heartbeat, nausea, weight gain, problems thinking or concentrating, and a persistent unexplained cough (that may or may not bring up white or pink mucous). As heart failure becomes more advanced, all these symptoms tend to be less subtle. “The fatigue may become so great that someone can’t complete their daily activities,” Makaryus says.  

It’s important to note that many cases of heart failure pass through an early stage when there are no noticeable symptoms. However, at this stage the condition may already be detectable using certain blood tests. “We now have sensitive and specific biomarkers that can identify the earliest molecular changes in the heart that precede more overt structural change,” Pop-Busui says. There are drug therapies available that are proven to reduce the progression of heart failure, and catching the condition at this early, asymptomatic stage can help doctors improve outcomes for their patients. On the other hand, some diabetes medications can contribute to the development of heart failure. If the condition is caught early, someone with diabetes can get off these drugs before the condition progresses. “Early diagnosis can help make sure that people with diabetes have access to the best treatments at the right time,” Pop-Busui says. 

Treatment options

The standard, first-line treatments for heart failure are medications, and experts say the drugs they choose are based on the severity of the condition. “We look at something called the ejection fraction, or the squeezing strength of the heart, to determine the appropriate treatment plan,” Januzzi says. 

If a patient’s ejection fraction is reduced—meaning their heart is not pumping as strongly as it should—treatment usually includes several classes of drug that are designed to widen blood vessels and improve blood flow. “There are four main classes of therapy we recommend,” he says. These include beta blockers, aldosterone blockers, a medication called sacubitril/valsartan that widens blood vessels, and what’s known as an SGLT-2 inhibitor, which not only lowers blood pressure but also helps reduce blood glucose levels. (SGLT-2 inhibitors are often used to treat diabetes even absent heart failure.)

“For people with preserved ejection fraction, meaning anormal squeezing strength, therapeutic options are more limited,” Januzzi says. “However, recent clinical trials of SGLT-2 inhibitors showed benefit in these individuals, so these should be now considered in anyone with heart failure, but especially in people with diabetes.” 

“In my opinion, these are very important drugs,” Makaryus says of SGLT-2 inhibitors. “Initially these were marketed as diabetes medications because they have blood sugar lowering effects, but clinical trials have found they improve outcomes and all-cause mortality from major cardiovascular events, including heart failure.” He says that another newer class of drug called GLP-1 agonists has also demonstrated benefit in people with both diabetes and heart failure, and is likely to be used more frequently to treat these co-occurring conditions. 

The drugs used to treat heart failure in people with diabetes are often the same drugs prescribed for those without diabetes, but there’s evidence that they work even better in people with both conditions. “I tell my patients with diabetes they can expect even larger reductions in risk than someone without diabetes,” Januzzi says.  

Apart from drugs, lifestyle and behavioral changes can make a meaningful difference for people with heart failure. “This includes increasing exercise whenever possible,” Januzzi says. “This also includes paying attention to one’s mood.” Depression and anxiety are both associated with poorer outcomes in people with heart failure, he says, so it’s necessary to address these mental health challenges (with therapy, for example) if they appear. 

“Diet and weight loss are also critically important,” Januzzi says. “At our institution, we often recommend a Mediterranean-style diet that includes more complex carbohydrates and a judicious amount of protein.” While there’s a lot of strong research supporting the health benefits of Mediterranean-style diets, he notes that people with diabetes and heart failure should ideally work with a medical dietitian or nutritionist to create a custom eating plan. “Each individual patient has their own set of medical issues that might need to be considered,” he says. There’s no optimal, one-size-fits-all diet for people with diabetes and heart failure.

Read More: How COVID-19 Changes the Heart—Even After the Virus Is Gone

Preventing heart failure

While everyone should prioritize heart health, taking steps to lower your risks for heart failure is especially important if you’ve been diagnosed with diabetes. “Even for those individuals with relatively new-onset diabetes, the condition may have been present for a while, and so the clock has already been ticking,” Januzzi says. “There’s no better time than now to focus on wellness.”

Controlling your risk factors for heart failure is step one, and that means not smoking, first and foremost, and also managing your cholesterol, blood pressure, and blood glucose through a combination of diet, exercise, weight loss, and medication therapy. “I also encourage my patients with diabetes to educate themselves so they understand their condition and the early warning signs of heart failure,” Januzzi says. Keeping yourself informed on the latest regarding your disease, your risk factors, your medication options, and your screening options is still a good idea. “I always advise my patients to be their own advocates,” he adds.

Heart failure is a common complication for people with diabetes. But with the right plan, you and your care team can take steps to effectively prevent or treat the condition.

For many people, stress is part of everyday life. The demands of work, family, and other quotidian pressures can leave one feeling angry, agitated, anxious, downtrodden, or burned out.

While these kinds of day-to-day challenges are often described as mild forms of stress, the reality is that some people will experience them more often and more significantly than others. And there’s mounting evidence linking these and other forms of stress to heart-related health problems.

“We know from several studies in different populations that emotional and psychological stress is associated with an increased likelihood of developing and dying of cardiovascular disease,” says Dr. Beth Cohen, a stress researcher and professor of medicine at the University of California, San Francisco. 

For example, research on stress in the workplace has found that people who are under regular strain or who work long hours are up to 40% more likely than their less-taxed counterparts to eventually develop heart disease or stroke. “There are also studies looking at what we call perceived stress, which is the amount of stress a person reports feeling, regardless of cause,” Cohen says. There again, research has found that people who report feeling a lot of stress are at elevated risk for cardiovascular problems down the road.  

Meanwhile, some of Cohen’s work has examined the health effects of stress that stem from deeply traumatic experiences—such as those related to military combat service or interpersonal violence. She says post-traumatic stress disorder (PTSD) and other stress-related disorders are associated with increased cardiovascular disease risks. 

But while stress appears to be a major risk factor for heart trouble, there’s a lot about the relationship between stress and heart health that experts are still sorting out. For example, how much stress is too much? “Not all challenging or stressful situations are unhealthy,” Cohen says. “Short-term stress in specific situations, such as working to overcome a difficulty, may actually be beneficial.” Another lingering question: Does stress itself damage the heart, or does stress lead to other things (smoking, poor sleep, an unhealthy diet) that cause the bulk of the harm? These are the types of questions that science has not fully answered.

Untangling the exact relationship between stress and health problems—including heart disease, but also other stress-related conditions such as Type 2 diabetes—is now the goal of research teams across the world. They’ve made progress in showing how stress may change a person—both inside and out—in ways that could contribute to heart trouble.

Read More: Feeling Off? It Could Be ‘Ambient’ Stress

Defining stress

In order to understand the negative effects of stress, medical researchers must first define what it means to be “stressed.” That’s easier said than done. 

“There’s the lay-person idea of stress, but defining it more scientifically is challenging,” says Dr. Ian Kronish, an associate professor of medicine and associate director of the Center for Behavioral Cardiovascular Health at Columbia University in New York. 

For example, some researchers have defined stress as “[a]ny physical or psychological stimuli that disrupt homeostasis.” By this broad definition, watching a suspenseful TV show or hurrying to an appointment are both forms of stress. Both are likely to raise a person’s heart rate and blood pressure in measurable ways. But most experts, like laypeople, recognize that these fleeting periods of stress probably aren’t the kinds that contribute to heart problems.

Another definition of stress is one that encompasses experiences or events that lead to unhelpful changes within the body’s stress-response system. It’s these disruptive forms of stress, Kronish says, that may contribute to heart disease and other health issues. These forms of stress are often sorted into two types: acute stress and chronic stress. 

Acute stressors are experiences that lead to very intense activation of the body’s fight-or-flight response. “These are events where the demands of the situation outstrip a person’s resources to handle them,” Kronish says. “Living through a major disaster, whether from natural causes or something like a terrorist event, could be the kind of acute stress that leads to disruptions within these internal systems.” Chronic stress, meanwhile, refers to stressful experiences that may not pose an immediate threat to someone’s health, but that happen regularly and persist for long periods of time. Working in a hectic and draining profession is one example of a chronic stressor that, over time, could lead to perturbations of the body’s stress-response system.

While acute and chronic stress may seem like straightforward concepts, nailing down when and how they harm a person’s health is difficult. Different people will respond to the same stressful situation in different ways; not all veterans with combat experience develop PTSD, and not all people who work in demanding professions develop adverse health effects. There’s also evidence that other lifestyle or environmental factors—such as a person’s exercise habits, their diet, and their social relationships—can help determine whether stress leads to health problems. “When I try to draw this out for people, it ends up looking like a big spider web of connections,” Cohen says. “All of these other things that are important to a person’s psychological and cardiovascular health may affect how they’re impacted by stress.”

It has also been a challenge for researchers to measure stress. “With stress, we don’t have something like blood pressure where I can sit you down and measure it and know exactly what it means,” Cohen says. Likewise, when someone with a history of stress develops heart trouble, there is currently no way for experts to determine whether stress caused that person’s health problems. “We don’t have a test that can tell whether your heart has been impacted negatively by stress,” Kronish says. 

In an effort to address these and other gaps, researchers have focused much of their attention on mapping out the underlying connections between stress and health. That work has revealed how acute and chronic stress may contribute to heart trouble, diabetes, and other health problems. 

The stress-heart connection

The human body reacts to stress in predictable ways. Blood pressure and heart rate increase, while breathing becomes shallow and rapid. Muscles grow tense and blood sugar levels rise. Alertness and attention sharpen. This all happens because stress-related hormones are circulating throughout the brain and body, ramping up activity in the sympathetic nervous system (SNS) and preparing the entire organism to respond to any potential threats. While SNS activation is the kind of stress a person can feel, a lot more is going on inside them. In fact, stress affects the operation of every organ and system in the body, including the immune system. 

All of this is normal and healthy. The body is made to manage stress, and, typically, it will recover from periods of stress without any lingering ill-effects. But in those situations when a stressful event is very severe, or when stress lingers for long periods of time, changes may occur that threaten the heart. “Increases in blood pressure, which can be initiated by stress, will increase pressure on the walls of blood vessels, and can therefore lead to cardiovascular damage,” says Dr. Amgad Makaryus, a cardiologist and professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health in New York. 

The effect stress has on blood pressure is just one of many theorized ways that stress may lead to heart trouble. “With stress, it’s difficult to pinpoint the exact way it’s doing damage, but we know one of the end products of stress is inflammation,” Makaryus says. While stress usually leads to temporary increases in inflammatory activity, chronic stress can produce persistent low-grade inflammation. This sort of simmering, all-the-time inflammation has been tied to heart disease, but also to Type 2 diabetes, depression, and other illnesses of the mind and body.

While there’s good evidence supporting the theory that too much stress damages the body via heightened inflammation and other forms of internal dysregulation, experts say there are still a lot of details to be worked out. “The field is still trying to untangle the various biological and behavioral pathways that may connect stress and cardiovascular health,” Kronish notes. His group has spent a lot of time looking at the ways stress changes a person’s behavior in ways that may lead to health problems. He says stress motivates some people to take better care of themselves, but it can also lead people to forgo exercise and social gatherings, to smoke or drink more than they otherwise would, and to adopt other habits that imperil their health. “Sleep is another pathway that might connect stress to poor cardiovascular outcomes,” he says. There’s evidence that stressed people tend to sleep poorly, and a persistent lack of sleep has been associated with a wide assortment of health problems. 

Untangling all these different stress-related harms—both the biological and the behavioral—is no easy task. They’re likely all interconnected. “People talk a lot about a dysregulated stress system, but my sense is it’s a more complicated story,” Kronish says. “There are so many factors to tease apart.”

Read More: How COVID-19 Changes the Heart—Even After the Virus Is Gone

How to reduce your risks

Stress appears to threaten the heart in numerous ways. Safeguarding the heart from that assault may require a multi-pronged defensive strategy, experts agree. “People hear that stress is bad for the heart, and so they should do things to reduce stress,” Kronish says. “But the truth is we don’t have a grand slam stress-reducing intervention that we know will protect the heart from stress in all people.”

For example, psychotherapy has shown promise for the reduction of both stress and its attendant heart risks, and Cohen recommends it for people with PTSD and other stress-related mental health conditions, such as anxiety, depression, and trouble sleeping. But the evidence supporting its protective benefits for the heart is inconsistent. “Some trials have looked at psychotherapy and stress reduction techniques,” she says. “They’ve consistently led to better mental health outcomes, but they’ve had mixed evidence in terms of whether they reduce heart disease risk.”

Meanwhile, Makaryus says medication-based treatments aren’t the answer—at least not yet. “Medications are a big part of cardiovascular disease treatment, but we don’t have an easy pill that will solve this,” he says of stress-related heart trouble. “I think the key is prevention.”

It may not be surprising, but he and others say the time-tested elements of a healthy lifestyle—regular exercise, a proper diet, good sleep, and time spent with friends—can help a person recover from stress and reduce their risks for stress-related health problems. “Many people deal with stress by connecting with family and friends, or connecting with a spiritual group,” Cohen says. Leaning on other people for support—as opposed to isolating yourself and dealing with stress on your own—seems to be one of the best ways to reduce its harms, she says. 

For many of us, stress is inescapable. But we all have the power to eat better, exercise, and engage in other healthy activities that appear to help limit the harms of stress. “There are mysteries left to unravel,” Cohen adds, “but we already know many ways how to preserve and protect cardiovascular health.” 

The human heart is a muscle, but it’s also a kind of complicated balloon—a balloon that fills and empties roughly 60 to 100 times every minute, and several billion times during the course of a lifetime.

Among people with hypertrophic cardiomyopathy, the walls of the heart muscle are abnormally thick. This thickness can interfere with the heart’s normal filling-and-emptying operation. “If you think of a balloon made with super-thick rubber, you have to blow harder to fill it, and it’s the same with a hypertrophic heart,” says Dr. Daphne Hsu, professor of pediatrics and medicine at Pediatric Heart Center of Montefiore/Einstein in New York. 

Hypertrophic cardiomyopathy is the most common form of genetic heart disease in the U.S. and the second commonest heart-muscle disease among children. Roughly 1 out of 500 adults is thought to be living with it. It’s unclear exactly how many American kids have the condition, but experts estimate its prevalence somewhere in the neighborhood of three cases per 100,000 children. That makes it a very rare disease. However, despite its uncommonness, hypertrophic cardiomyopathy is one of the leading causes of sudden death in young athletes. While it’s true that the condition can in some cases be life-threatening, it can also be almost very mild. “A lot of patients do not have many symptoms and their quality of life is good,” Hsu says.

Here, she and other heart experts explain the basics of hypertrophic cardiomyopathy in children—including the different forms of the condition, how it’s identified and treated, and how it affects a young person’s health as they mature into adulthood. 

Types and causes 

Hypertrophic cardiomyopathy, like most other diseases, can range from mild to severe. In some cases, the heart’s functioning is only minimally impaired—if it’s impaired at all. In other cases, however, the heart’s ability to function properly may be significantly disturbed or weakened.

While all cases of hypertrophic cardiomyopathy involve abnormal thickening of the heart muscle, this thickening may or may not cause obstructions (blockages). In some cases, hypertrophic cardiomyopathy leads to heart rhythm problems (aka arrhythmias), and it can also disturb the way blood flows into and out of the heart’s chambers. Put another way, two children who both have hypertrophic cardiomyopathy may nonetheless have very different experiences and require very different types of treatment.

The underlying causes of hypertrophic cardiomyopathy are similarly diverse. In most adults, and likewise in many children, the condition stems from genetic abnormalities. “There are many, many genetic mutations associated with hypertrophic cardiomyopathy,” Hsu says. (They number in the dozens.) While experts have identified a lot of the mutations that cause hypertrophic cardiomyopathy in adults, the condition is not as well-mapped in kids. “We’re learning more about [these mutations] and we’re working on better techniques to measure them, but right now we don’t know most of them,” she says. While these mutations may be inherited from one’s parents, that’s not necessarily the case. “Sometimes genetic mutations occur spontaneously,” Hsu says. “Often if we do testing, we don’t find the [hypertrophic cardiomyopathy] mutations in either of the parents.”

Apart from mutations that specifically cause hypertrophic cardiomyopathy, the condition can also develop as a complication of a metabolic disorder. “Infants and very young children can have it because the heart muscle’s metabolism is not right, meaning there’s an accumulation of things like sugars that make the heart muscle thicker,” she explains. In these cases, hypertrophic cardiomyopathy is often just one aspect of a broader and systemic illness that affects the brain, the liver, and other organs. According to research in the journal Heart, these cases represent less than 10% of all childhood hypertrophic cardiomyopathies, and they’re almost always recognized at birth, as opposed to later on during childhood or adolescence.

Read More: What to Know About Damar Hamlin’s Heart Event, Commotio Cordis

Living with hypertrophic cardiomyopathy

The main symptoms of hypertrophic cardiomyopathy are shortness of breath, fatigue, chest pain, heart palpitations (a fluttering feeling), and light-headedness (often just after standing or sitting up). These symptoms may be mild or unnoticeable. They may also be moderate or severe. “What life looks like depends on whether a child has signs of heart failure or arrhythmia, but heart failure is not very common,” Hsu says. In many cases, symptoms become more noticeable following physical activity; exercise causes the heart to beat faster and pump more blood, and this exertion can make hypertrophic cardiomyopathy worse. 

While sudden cardiac death is possible, the risk of this happening varies from one child to the next. “The risk of cardiac death among all children with hypertrophic cardiomyopathy is approximately 1.5% per year, but some kids are at greater risk than others,” says Dr. Juan-Pablo Kaski, a pediatric cardiologist and director of the Centre for Paediatric Inherited and Rare Cardiovascular Disease at University College London. “There are clinical models we can use to estimate the risk for a particular child.” 

Depending on that risk, some kids with the condition may be advised to avoid sports or strenuous exercise. But that’s not always the case. “Most children can do all the things their peers would do,” Kaski says. “The only difference is they need to come to a clinic every six months to a year for a checkup.” 

There was a time when pretty much all children with hypertrophic cardiomyopathy were advised to avoid vigorous exercise, but the thinking on that has changed. “There’s been a trend to have more freedom for sports participation,” says Dr. Jeffrey Geske, a cardiologist and hypertrophic cardiomyopathy specialist at the Mayo Clinic in Minnesota. This shift has happened in part because experts have become more adept at identifying the people who are most at risk for sports-related complications or death. “We also know that sports and activities are good for people,” Geske adds. “So it’s about balancing the risks and the benefits.”

Hsu echoes these sentiments. “It’s not healthy for a child’s body or mind to be restricted from normal activities and sports,” she says. “There are many kids with hypertrophic cardiomyopathy who play sports, but the decision to allow a child to play requires extensive discussion between the cardiologist and family.”

It’s also worth noting that sudden cardiac death does not always occur as a result of exercise. “Most children who die don’t die during exercise,” Kaski says. “They die during normal day to day activities.” Again, while the risk of sudden death is elevated in kids with the condition, it is nonetheless uncommon.

Read More: 7 Myths About Cholesterol, Debunked

Diagnosis and treatment

Hypertrophic cardiomyopathy is usually identified and diagnosed in one of three ways. “One is through family screening,” says University College London’s Kaski. In these situations, a child’s parent or relative is diagnosed with the condition, and follow-up screening reveals that the child also has it. “The second way is that a child has symptoms—so things like breathlessness during exercise, chest pain or palpitations, or near-fainting episodes—and that triggers a referral [to a heart specialist],” he says. “The third way is through incidental finding.” In these cases, health care providers spot the condition while performing routine medical exams, or while looking for something else. 

Once the condition is diagnosed, Mayo’s Geske says that treatment is often dictated by a person’s symptoms. “If somebody has no symptoms, then often no treatment is needed beyond some lifestyle modifications,” he says. These lifestyle changes may or may not include avoiding heavy exercise. Kids (and adults) with the condition are also usually advised to drink plenty of water or fluids because dehydration can make symptoms worse, Geske says. A healthy diet and regular exercise are also recommended. 

The symptoms of hypertrophic cardiomyopathy, whether mild or severe, tend to stem from two particular complications: heart arrhythmias and heart failure. Heart failure happens “when the heart can’t fill or pump out as well as it should, and the heart can’t supply the body with the blood it needs,” Hsu says. Heart arrhythmias happen when the hypertrophied muscle causes electricity to travel through the heart in an abnormal way, and as a result the heart may have unusual rhythms.”

Doctors treat these complications with medications, surgical procedures, and/or implanted heart devices. “So if there’s heart failure, we have drugs that help the heart fill and empty better,” she says. These include beta blockers, calcium-channel blockers, and other drugs that are also used to treat heart failure in adults. Medications tend not to work well for heart rhythm problems, she says, and so these arrhythmias—if severe—may require surgical intervention or the implantation of a pacemaker. (Hsu says this isn’t as common in kids as it is in adults.) 

Hypertrophic cardiomyopathy can also block the flow of blood through the heart. These blockages usually require surgical intervention. In rare cases, a heart transplant may be necessary. “The ultimate treatment is taking out the heart and giving a new one, and this works well—people do well after a transplant,” Hsu says. 

Long-term outlook

Experts say the long-term prognosis for a child with hypertrophic cardiomyopathy can be hard to pin down. Some go on to live long lives free of major symptoms. “The vast majority, I would say, have a good quality of life and good life expectancy,” Kaski says.  

However, complications such as heart failure or arrhythmias, even if mild during childhood and adolescence, can grow worse during adulthood. “The progression [of heart complications] seems to be more quick when hypertrophic cardiomyopathy is diagnosed in childhood,” he says. “So the thickening of the heart muscle or abnormal heart rhythms—all that tends to happen more quickly.” 

Hsu says that kids with the condition may be at greater lifelong risk for heart trouble, although she says this is more a matter of educated guesswork than established fact. “We don’t have a database going back 50 or 100 years, so we really don’t know a lot about long-term outcomes,” she says. “In general, we know if you have heart disease as a child, you usually have more severe disease as you get to 40 or 50 and beyond.” But every patient is unique. 

Overall, experts say the situation for a majority of kids with hypertrophic cardiomyopathy is far from dire. In fact, a lot of kids who have it may never even know about it. “When a patient is first diagnosed, you go and Google this condition and a lot of scary stuff shows up,” Geske says. “But most people with this disease have a normal life span.”

Experts are learning more and more about the condition every day. While prospects for most kids with hypertrophic cardiomyopathy are already good, they’re sure to improve as medical science’s understanding of this disease expands and deepens in the years to come. “We now have the ability to recognize people at high risk, and we have more effective interventions,” Geske says. Things are all moving in the right direction.