Stopping a Killer of Young Athletes

Cardiologist Dr. Srihari Naidu has become one of the first interventional cardiologists in New York to routinely treat hypertrophic obstructive cardiomyopathy (HOCM), a thickening of the heart's muscle, using a minimally invasive procedure known as alcohol septal ablation.

The procedure involves inserting a thin catheter into the groin and, using an artery as a pathway, moving the catheter toward and eventually into the heart. Once inside, an alcohol solution is released from the catheter, making contact with the excess muscle and causing it to wither away.

	Dr. Naidu, at table, moves a cathether inside the patient's artery.
	Afterwards, Dr. Naidu reviews images from the procedure.

"What we are essentially doing is creating a carefully controlled heart attack," says Dr. Naidu. "However, in this case, we are killing off muscle that is actually hurting the heart – not helping it." The technique replaces an open heart procedure where surgeons have to open a patient's chest and physically cut away excess heart muscle.

HOCM is believed to be caused by a genetic defect that is inherited by about half of a carrier's offspring. Instead of lying neatly together, the cells that create heart muscle arrange themselves in haphazard patterns, creating muscle that is abnormally thick. This occurs most commonly in the septum, the muscle or wall separating the heart's right and left ventricle.

As the septum thickens, it can grow to block the flow of blood out of the heart, causing pressure to build up within the chamber and blood to be regurgitated back into the lungs. Patients experience fatigue, shortness of breath, palpitations, chest pain or angina, and lightheadedness or fainting – usually during exercise. In some cases the situation can prove fatal. HOCM is actually the largest killer of young athletes.

Dr. Srihari Naidu

Determining if someone has HOCM involves a physical exam and comprehensive evaluation, which includes an echocardiogram (heart ultrasound). Medication is generally the first line of treatment, followed by a procedure such as septal alcohol ablation, if medicines do not bring adequate relief.

Dr. Naidu is an assistant professor of medicine in the Greenberg Division of Cardiology at Weill Cornell Medical College and an assistant attending physician at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.