Confusion about thickness

[Dave Johnson]

I've been reading around some other threads and am hearing comments such as "Don't forget the heart is a muscle and exercise makes it stronger and in our case THICKER, which is not good." Is this true?

I understand the strenuous excersice is bad long-term, but I was in Boston last week and my understanding from Dr. Maron was that I couldn't really do anything to either slow or speed up progression or affect thickness. Did he mean in my case specifically (I'm 1.4 and non-obstructive)? He did ask what types of activities I wanted to do and they are all pretty mild (cardiovascularly speaking). If I'd told him I wanted to take up mountain biking and kickboxing, I'm pretty sure he would have discouraged me.

The bottom line is that I thought so long as I can endure the symptoms, I shouldn't be scared to be more active. I know there's limitations because of the symptoms, and there is a balance, but this information seems conflicting. Does exertion (and onset of symptoms) equal thicking and progression or not? I'll call Dr. Maron Monday, but I'm interested in what you guys know as well.

[Pat]

Re: Confusion about thickness

Dave,

I think the keys here are (1) just how strenuous the exercise is and (2) the difference between the muscle fibers in the normal athlete's heart and the HCM heart.

Strenuous exercise (like running marathons, being a professional athlete, etc.) will increase the thickness of the heart muscle, just as it strengthens all exercised muscle. In a normal heart it's not a problem because the muscle fibers are in an orderly alignment and the heart continues to function well. But it can be difficult on an echo to tell whether this is an athlete's heart or HCM without obstruction.

The muscle fibers in a heart with HCM are disorganized--they don't lie in an orderly alignment. This makes cardiac function more difficult. Strenuous exercise could further thicken the muscle, making function even more difficult.

But you're clear that what you discussed with Dr. Maron is non-strenuous exercise. The symptoms of shortness of breath, angina, and dizziness are going to keep you from those strenuous forms of exercise, I think! And the occurrence of those symptoms does not mean your heart muscle is getting strengthened or thickened. I don't think you should worry about being normally active.

You might ask Dr. Maron for guidelines as to how fast you can let your pulse get. That would give you an objective reference point for deciding whether you're overdoing activity or not.

Pat

[Linda]

Re: Confusion about thickness

Dave, Pat has given you good info. When you talk to Dr Maron, ask him to elaborate on this point for you. He can talk specifically to your situation. Lab studies with mice have been reported to have shown greater increases in thickness with increased intensity of exercise. It is my understanding that these little critters were involved in some pretty intense swimming, not what your average mouse would ordinarily choose for his afternoon activity. Linda

[Lisa Salberg]

Re: Confusion about thickness

Dave,
I was attempting top reply to this post Saturday when my internet crashed! Pat and Linda have said what I was going to say so I will simply say ...thank you ladies nice answers!
Be well,
Lisa

[Darren1]

Re: Confusion about thickness

ok, so let me see if I follow the answers here... extensive exercise can (possibly) cause thickening of the heart. The jury is still out? Yea, the structure of the muscle is messed up in those of us with HCM, but does having a heart that is physically conditioned make us more or less vulnerable to sudden death/ other problems? It seems the jury is out on that as well. It seems logical that a STRONGER and thicker heart would fair just as well as a weaker and thinner heart... is that not the case? If so, then what advantage do we have in not remaining active? I realize that strenous exercise can bring about sudden death, but being a couch potato isn't equally (if not more) dangerous? I haven't seen many real answers to these questions. Just circular responses. What STATISTICS are their about this illness? What about life expectancy based on thickness and/or lifestyle (and or stress level)...

[Karen P]

Re: Confusion about thickness

I can't imagine either of these two extremes, strenuous exercise or couch potato, being healthy for someone with HCM. A happy medium, mild/moderate exercise, sounds healthier and safer all around.

Dave, I never heard that strenuous exercise can directly impact the progression of thickness in an HCM heart. Did you have that conversation with Dr. Maron? I know that extreme activity should be avoided, not only since it can produce dangerous rhythms, but it's also the root of exhausting symptoms for many HCMers.

Darren, physical exertion is essential for the heart, lungs, blood and mind and can cause other problems without it. A physically conditioned heart has to be better in the long run, but... how you're getting into that 'physically conditioned way' is the question. There can't be an advantage to a sedentary lifestyle.

I don't have an answer regarding 'stats', but I do remember reading an article in the 'research' forum regarding life expectancy and gradient. I don't know if that will help. I know....this response was pretty circular also.....huh?!?! Sorry laddie, but maybe Dave can share more light on the subject from Dr. Maron.

Take care,

Karen

[Sarah]

Re: Confusion about thickness

Dear Darren,

HCM has not been recognized as HCM long enough to have a deep body of stats on what you are asking about (as far as I know). Also, some of the stats on mortality are overstated due to over-reporting from major centers (not that they reported more deaths than they had, but other HCM patients who DIDN'T die were not included to create an accurate percentage).

The trick in your question is "conditioned heart." Professional athletes (or those who emulate their exercise routines) will naturally have thicked heart muscles, however, those changes are over the whole heart and lead to larger heart chambers to pump more blood. In an HCM patient, the thickening leads to smaller chambers that pump less blood, which is bad right off the bad and then even worse under exertion.

So, no, an HCM heart is not going to do better if it is conditioned. And despite the fact that the annual mortality of HCMers is only about 1%, way too many of those deaths happen on the field, in sprint-like sports such as basketball, for any doctor to recommend competitive sports to their patients.

But being a couch potato isn't healthy either. Luckily, there are things like walking, yoga, golf, bowling, badminton, tai chi, qi gong, biking, light hiking, some light rock climbing perhaps, that will keep you moving without the high risk of weight training, basketball, or football.

I hope this clears things up a tiny bit.

S

[Robert Hartwell]

Re: Confusion about thickness

As I recently went through this with my HCM specialist, let me add my insights to this discussion. Please keep in mind that this may not apply to everyone.

As stated in earlier posts, strenuous exercise is not recommended due to possible affects on the heart such as reduced function or bringing on arrythimas. However, one should consider the total health of the cardiovascular system. I believe that mild exercise, as recommended by ones doctor is key to acheiving this. It will help with stamina, muscle strength, level of exertion, and general well being. In my case, it is also a good help with weight loss . Since I have been exercising regularly, about 4 - 5 times per week, I have seen some pretty dramatic changes both physically and mentally. My HCM doc recommended that I become more physically active, gave me the do's and don'ts and set a target heartrate that I can't exceed.

Bob

[Lisa Salberg]

Re: Confusion about thickness

Like most things in life moderation seems to be the key. To much excersice can make the heart "stronger" which for those with HCM is not good as our hearts are already "too strong"...lack of mobility is poor to as it hurts us in many ways and it is simply not healthy to sit around all day.
SO where are we.... in the middle - stay active - no weight lifting, no competitive sports but stay as active as you can.
I think it is good to think about the actual heart being bound with all the muscle that an HCM heart has.... think about how hard it must be for something so "thick" to relax...now think of a "normal" heart and not how much easier it must be for that heart to relax. Our "pumps" work well...in fact they work too well and that is where the problem is. Lets not add to the "problem" lets give our hearts the room to pump and room to relax.
Lisa

[Shelley]

Re: Confusion about thickness

hehehe - Dr. Maron sure gets around...he diagnosed me, but in Minneapolis. Back to the topic at hand....I really would like to know just how dangerous it is for us to do cardio exercise. How much is moderate?

[Sarah]

Re: Confusion about thickness

Dear Shelley,

Dr. Barry Maron is in Minneapolis and his son Marty is in Boston.

S

[Bert]

Re: Confusion about thickness

From what I've gathered anything that is not too intense is probably probably just fine. Risk stratification as it pertains to exercise is far from being resolved. I've had Dr. Maron tell me that he's aware of a college student collapsing with SCD on his way to class and on the other hand a long distance runner who continues to run with HCM and is doing great. So, anything in between is what we're working with here. I agree with previous posts that everything in moderation is the way to go, with the exception of sex of course, I figured Celtic would like that one.

Hey! Did any of you see the signs during the Tampa Bay Lightning New Jersey series? The sign read "Safe is Death" which referred to their reckless and offensive minded style of play that had gotten them that far. Well ultimetly they did die. They were eliminated by the Devils who were far more conservative and actually play a boring but effective brand of hockey. It's all on how you want to play the game...

Take care folks.

[Lisa Salberg]

Re: Confusion about thickness

Bert - Are you picking on our Jersey teams? I am not big into Hockey as my brother (who is) can tell you but I think your picking on one of the only pro teams Jersey really has -

GO DEVILS!

Ya like that Lar!

Lisa

[bryan]

Re: Confusion about thickness

Lisa,
Dont forget about the Nets who are up 1 one my Celts!!!

[Karen P]

Re: Confusion about thickness

Go METS !!!!!
I can dream.......can't I??