Christopher Kramer, M.D.: The Importance of Comprehensive Care in HCM

Twenty years ago, patients with hypertrophic cardiomyopathy (HCM) were advised to avoid exercise due to safety concerns. However, Christopher Kramer, M.D., chief of the Division of Cardiovascular Medicine at the University of Virginia, explains that recent data from large, National Institutes of Health-supported studies indicate that even vigorous exercise is safe for HCM patients. He encourages physical activity, noting that even brisk walking is beneficial. Maintaining a healthy weight is also important, as weight gain is detrimental to managing HCM and overall health.

In an interview with The Educated Patient, Kramer shares his insights on the management of HCM and provides advice for patients. He will serve as vice president of the American College of Cardiology in 2024-2025.

Kramer notes that diet might not play a significant role in HCM management, but hydration is crucial, particularly for patients who have obstructive cardiomyopathy. He emphasizes the importance of maintaining adequate hydration, especially in hot weather or during exercise, as dehydration can increase the risk of obstruction, leading to symptoms like dizziness or fainting. Staying well hydrated and maintaining proper volume is essential for these patients.

About 30% to 40% of patients have a clear sarcomere mutation, which is hereditary and can be passed on to family members with a 50% chance of inheritance (autosomal dominant). For these patients, Kramer says it’s crucial that family members undergo screening with an echocardiogram and consider genetic testing. The other 60% of patients do not have a single gene mutation but rather a polygenic risk, involving multiple genes that increase the propensity for HCM. In these cases, environmental factors like high blood pressure or obesity can trigger the development of HCM. Although this form is less directly hereditary, Kramer still recommends that first-degree relatives — siblings, children and parents — get screened.

Kramer also highlights the importance of a comprehensive evaluation with a cardiologist for patients experiencing symptoms like shortness of breath or chest pain, as there are multiple potential causes in HCM. A complete echocardiogram, and possibly a stress echocardiogram, can help determine the underlying mechanism, which is essential for tailoring treatment. Knowing whether the patient has obstructive or nonobstructive HCM can guide the approach to managing symptoms.

Patients should be alert to any progression in symptoms, such as increased shortness of breath during daily activities; difficulty climbing stairs, walking or bending over; or chest pain, fainting, palpitations or a rapid heartbeat. These changes should prompt them to contact their doctor.

Kramer points to several resources for patients seeking more information, including the American College of Cardiology, which provides educational materials, and the Hypertrophic Cardiomyopathy Association, a patient advocacy group that offers a comprehensive website with information, support and chat rooms for patients to connect with others who have experienced similar challenges.