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On the surface, it all looks nice and shiny; energetic and unstoppable, even.

However, a threat seems to be lurking around the corner and creeping up silently in the lives of young adults.

What is it?

It’s called hypertrophic cardiomyopathy (HCM). Often symptom-free and misunderstood, this genetic heart condition thickens the heart muscle, especially in the left ventricle, making it harder to pump blood and increasing the risk of dangerous heart rhythms and sudden cardiac death. And mistake not for its ‘silent’ nature, it can strike without warning.

Characterized by thickened heart muscle, HCM reduces the heart’s pumping efficiency and often hides behind vague symptoms like shortness of breath, fatigue, or fainting. Because many affected individuals are asymptomatic or misinterpret symptoms as stress or poor fitness, this condition often goes unnoticed until a serious event, such as sudden cardiac arrest.


What Is Hypertrophic Cardiomyopathy?

HCM is a genetic heart condition in which the heart muscle becomes abnormally thick, often impacting the wall between the pumping chambers, known as the septum. This thickening can narrow the pathway for blood to leave the heart (obstructive HCM) or simply make the heart stiffer and less able to fill and pump efficiently (non-obstructive HCM).

This increased muscle mass can also disturb the heart’s electrical system, raising the risk of dangerous arrhythmias and, tragically, sudden cardiac death, even in otherwise healthy young people. While many people with HCM live normal lives, the condition is the leading cause of sudden cardiac death (SCD) among young athletes and active adults under 35.


Why it’s called the ‘silent’ heart condition

Many individuals with HCM never experience noticeable symptoms; some estimates suggest up to 50% may remain symptom-free or only mildly symptomatic. Others may dismiss faintness, chest tightness, or breathlessness as normal fatigue or stress.

HCM is alarmingly common among young adults and athletes; studies show it’s the leading cause of sudden cardiac death in young athletes, accounting for nearly one in four such cases.


Why young adults are especially at risk

Young people with undiagnosed HCM may seem perfectly healthy, but they experience hidden danger. Older research suggested mortality rates up to around 6% per year in children with HCM, often due to SCD. However, recent advancements in treatments such as implantable defibrillators (ICDs), targeted medications, and surgical options have improved outcomes dramatically.

A study tracking nearly 500 patients aged 7 to 29 found a lower annual HCM-related death rate of about 0.5%, thanks to early intervention and modern treatment strategies.


Furthermore, family history is a key clue. HCM is inherited in an autosomal dominant pattern, meaning a child has a 50% chance of inheriting it from an affected parent.

Even elite athletes with no symptoms can suffer sudden cardiac arrest, as happened to high school wrestler J.J. at age 18 and an NBA player, Jared Butler, who learned of his diagnosis during a routine physical at 18 – cases that have drawn much attention to the ‘silent’ killer.


Overlooked and subtle symptoms

Many individuals with HCM don’t experience obvious symptoms or may ignore them:

Shortness of breath during exertion or even at rest

Chest pain or angina-like discomfort during activity

Heart palpitations, dizziness, or fainting episodes

Fatigue, swelling in the legs or abdomen, and unusual lightheadedness


These signs are often dismissed as stress, poor fitness, or non-serious ailments; delay in diagnosis is common. In some cases, sudden death is the first obvious indication of HCM.


Screening and early detection: Why it matters

Because HCM is often inherited in an autosomal dominant pattern, family history matters. Screening methods include listening for heart murmurs, plus diagnostic tools like ECG, echocardiograms, MRI, and genetic testing.

Early treatment can slow or prevent disease progression. A clinical trial found that young adults treated early with valsartan (a blood pressure medication) showed reduced physical progression of HCM vs. placebo.


Treatments of HCM

While HCM can’t be cured, it can be effectively managed. Management of HCM is likely to include:

Medications like beta-blockers, calcium channel blockers, disopyramide, and the newer FDA-approved drug mavacamten.

Implantable cardioverter-defibrillators (ICDs) for those at high risk of SCD.

In severe cases, surgical interventions, like septal myectomy or alcohol septal ablation, can relieve obstruction.

Shared decision-making with your medical team to tailor treatment based on your age, goals, and risk factors.

Lifestyle changes, including avoiding vigorous competitive sports, can reduce risk and improve quality of life.

Thanks to modern therapies, most individuals have a normal life expectancy and manage well with proper monitoring and support.


Living with HCM: What you should do

Be alert to subtle symptoms: don’t brush off fainting, fatigue, or shortness of breath.

Know your family’s heart history: First-degree relatives should get screened.

Get early and accurate testing if at risk: ECG, echo, MRI, and genetics can offer clarity.

Work closely with your care team: Use shared decision-making to choose the best management path.

Stay informed on new treatments: Medications like mavacamten and minimally invasive procedures offer promising options.


The parting thought

Hypertrophic cardiomyopathy is a silent, and often deadly, heart condition that hides behind normal activity, especially in the young and fit. But with awareness, screening, and early action, lives can be protected. If you or a loved one experiences unexplained breathlessness, fainting, chest pain, or palpitations, or has a family history of heart disease, talk to a doctor. A simple test could be the difference between tragedy and prevention. Catching HCM early can make it manageable, not deadly.