Heart & Cardiology/Me again HCM concerns


QUESTION: Hi you asked me to give a bit more detail about myself to help you come to a conclusion so i shall:

I have no family history of sudden deaths fainting or heart disease.

However i suffer from pvcs and other palpitations, I had several checks up which included an ecg, holter monitor a chest x-ray and a echo, which was done 1.5 years ago. One x-ray suggested an enlarged heart but the doctor later admitted that she was mistaken, as black males usually naturally have a large heart. Another doctor refuted all of that said my heart was at the normal size.

I have been fine, but my problem is that for at least a week and a half have been fatigued and my muscles have felt sore despite not doing any strenuous activities. I am a bit worried that i am suffering from late stage HCM, as this is something that can affect young black males and can be the cause of pvcs. FYI - I have a vitamin d deficiency but it's not so low that it would cause symptoms.

You think it's worth going for another echo and visiting the doc? Or should i just try to work through it? I hope this is enough information. If you want anything else just email.


Heart size on chest x-ray is non specific, and EKG has limitations also,  with the best way to initially diagnose heart enlargement being an echocardiogram. When looking at HOCM, there is significant increase in the thickness of the heart muscle and features on the echocardiogram such as wall thickness are useful. When findings between echocardiograms are discordant, i typically send my patients for an MRI scan to diagnose more definitively. Do you have specific details or values for the echo findings?

The muscle soreness you mention is not a typical symptom associated with HOCM. Fatigue and shortness of breath may occur, and in the setting of HOCM is typically due to the heart muscle being so thick that it doesn't relax properly. If i were you i would see a physician first to discuss the symptoms and rule out other causes and see if basic tests are required for reassurance. If there is concern for heart failure, which doesn't sound like it, an echocardiogram can be ordered at that time.

Hope that was helpful,

---------- FOLLOW-UP ----------

QUESTION: I just want to express my utmost gratitude for your reply. I really appreciate it.

About further details:

Save for what that doctor said about the size of my heart, before it was refuted, all my other tests (ecg,holter,x-rays) came back normal.

As for the fatigue, what happens is that i feel fine when i get up but the moment i exert my self, (going up the stairs, moving suddenly) I start to feel the strain in my muscles as if I have not rested properly (like a person who has just exercised). I found this worrying as like you said with hocm, a thick muscle does not allow the heart to relax therefore causing fatigue like symptoms. I don't feel weak overall just that strain then I want to rest.

However my echo results came back normal. Well the doctor tested me and said it was normal. I have not the result with me I'm afraid.

May I ask how long hcm would take to develop before expressing any symptoms? Is what what I described even suggest that disease? I just want my mind rested, but this fatigue, along with occasional pvcs continues to be a worry.

I hope this helps.

Hi Den,

From your heart testing, it doesn't appear you have concern for HOCM. That is reassuring. The only time i would seek repeated reassurance is if you have a known family history of the disease. If not its reasonable to follow clinically.

The muscle fatigue you mention is not related to the heart disease. HOCM may be associated with passing out, and shortness of breath on exercise type symptoms such as heart failure. Fatigue can be associated, but not specifically muscle fatigue, it is a disease of heart muscle, not skeletal muscle.

It doesn't sound to me as if theres anything wrong, but If I were you, and if its available, i would seek a second opinion from a local cardiologist to put the matter to rest and provide definitive reassurance,

Hope that was helpful,  

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Mustafa Ahmed MD


Cardiology, Interventional Cardiology, Cardiac Surgery, Hypertension, Pulmonary Embolism, Structural and Valve Disease


Board Certification Internal Medicine and Cardiology Interventional and Structural Cardiology


Multiple Publications In High Quality Peer Reviewed Journals. Internationally Recognized.

MD from The Royal Victoria University of Manchester, England Medicine, Cardiology, Interventional Cardiology, Research Training - University of Alabama

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