Apical hypertrophic cardiomyopathy is a rare heart condition characterized by the thickening of your heart muscle near the bottom of your left ventricle.

Apical hypertrophic cardiomyopathy (HCM) can cause symptoms like reduced exercise ability and shortness of breath.

The name can be broken into several parts:

  • Myopathy: This is a condition that affects your muscle tissue.
  • Cardiomyopathy: This is a condition that affects your heart muscle.
  • HCM: This is thickening of your heart muscle, which makes it harder for your heart to pump blood.
  • Apical HCM: This is a rare form of HCM that usually involves the bottom of your left ventricle. This area is also called the apex.

Read on to learn more about this rare condition including its symptoms, causes, and treatment options.

How common is apical hypertrophic cardiomyopathy?

HCM is estimated to affect about 1 in 500 people. About 25% of people with HCMs from Asian populations and 10% from non-Asian groups have apical HCM.

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Apical HCM doesn’t always cause symptoms. When symptoms do appear, they’re often general and can mimic those of other conditions. They may include:

Apical hypertrophic cardiomyopathy and exercise

HCM causes thickening of your heart’s left ventricle walls at its apex. This thickening can cause your left ventricle to not be able to pump as much blood.

Less blood pumping may lead to shortness of breath, especially during exercise since your tissues require more blood and oxygen during exercise than at rest.

Some doctors recommend for people with HCM to avoid vigorous exercise due to concern over sudden cardiac death. But, in a 2023 study, researchers found evidence that vigorous exercise wasn’t associated with a higher risk of sudden cardiac death in people with HCM.

HCM is linked to dominant genes passed through a person’s family for most people who have it. More than 1,500 different gene mutations have been associated with HCM.

Fewer people with apical HCM report a family history compared with people with other forms of HCM. Mutations are only identifiable in about 13–25% of people, with the most of these mutations occurring in the MYBPC3 or MYH7 genes.

HCM seems to be particularly common in Japan and other Asian countries compared with the United States. About three-quarters of people with HCM are male. Most people receive a diagnosis when they’re roughly between 30 and 60 years old.

Apical HCM can lead to complications like:

For some people, their first symptom is a severe cardiovascular event, such as:

The diagnostic process for HCM often starts with visiting a primary care doctor, who will:

  • review your personal and family medical history
  • perform a physical exam
  • consider your symptoms

If they suspect you have a heart condition, they may refer you to a heart specialist called a cardiologist.

The main test cardiologists use to diagnose HCM is an echocardiogram. This is a type of ultrasound that produces an image of your heart and can show the doctor thickened areas of your heart muscle.

For some people, a doctor will use a transesophageal echogram, where a probe is inserted down your throat while you’re sedated.

Other tests you may receive include:

Current treatment guidelines don’t treat apical HCM any differently from other forms of HCM.

If you don’t have any symptoms, a doctor may recommend regular monitoring alone. If you do have symptoms, they may recommend medications like beta-blockers or calcium channel blockers.

Rarely, if medications aren’t effective, you may require surgery. People with end stage heart disease may require a heart transplant.

HCM is often linked to gene mutations passed through families and may not always be preventable. You may be able to support your overall heart health by:

The symptoms of apical HCM are generally vague and can mimic those of many other conditions. It’s important to see a doctor if you notice any concerning symptoms like:

  • trouble breathing
  • shortness of breath
  • decreased exercise ability

Once you’ve received a diagnosis, it’s important to attend all your regular follow-ups and contact a doctor if you notice a change in your symptoms.

The outlook for most people with apical HCM is usually good, and it generally doesn’t affect your quality of life or life span. Your risk of sudden cardiac death seems to be lower if you have apical HCM than if you have another form of HCM.

Some of the risk factors for sudden cardiac death include:

  • history of cardiac arrest
  • family history of sudden cardiac death
  • unexplained dizziness
  • left ventricular thickness of more than 30 millimeters

Here are some frequently asked questions people have about HCM.

Is apical hypertrophic cardiomyopathy hereditary?

HCM is primarily caused by gene mutations passed through families. Fewer people with apical HCM have a family history than people with other forms of the disease. The contributing gene mutation is identifiable in up to a quarter of people with HCM.

Is apical hypertrophic cardiomyopathy dangerous?

Apical HCM can cause limited exercise ability and trouble breathing. It’s associated with lower rates of sudden cardiac death than other forms of the disease.

Can apical hypertrophic cardiomyopathy be reversed?

HCM may be at least partially reversible with exercise.

How long is life expectancy with apical HCM?

People with HCM usually have a typical life span. Most people aren’t at risk of developing serious complications.

Apical HCM often doesn’t cause symptoms. When symptoms do appear, they often mimic those of many other conditions.

A doctor can help you figure out if any particular treatment is needed for your condition. Many people with apical HCM have a typical life span and quality of life, although regular monitoring is often recommended.