From the Guidelines
A patient with Hypertrophic Cardiomyopathy (HCM), constrictive pericarditis, and diastolic dysfunction without edema would likely experience several overlapping symptoms, including exertional dyspnea, fatigue, chest pain or discomfort, palpitations, dizziness, and syncope. These symptoms occur because all three conditions impair the heart's ability to fill properly during diastole. In HCM, the thickened heart muscle reduces chamber size and compliance, as noted in the 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy 1. Constrictive pericarditis creates a rigid shell around the heart limiting expansion, while diastolic dysfunction means the ventricles cannot relax normally. The absence of edema suggests the patient hasn't yet developed significant fluid retention, though this may develop as the conditions progress. Symptoms may worsen with exertion, dehydration, or arrhythmias, which are common in HCM, as discussed in the 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy 1. The combination of these conditions creates a particularly challenging clinical picture with restricted cardiac filling from multiple mechanisms. Key symptoms to expect include:
- Exertional dyspnea (shortness of breath during activity)
- Fatigue
- Chest pain or discomfort
- Palpitations
- Dizziness
- Syncope (fainting)
- Orthopnea (shortness of breath when lying flat)
- Paroxysmal nocturnal dyspnea (waking up breathless at night)
- Exercise intolerance, as the patient may be unable to perform activities they previously could, due to the pathophysiology of HCM and its effects on diastolic function, as described in the american college of cardiology/european society of cardiology clinical expert consensus document on hypertrophic cardiomyopathy 1.
From the Research
Symptoms in Patients with Hypertrophic Cardiomyopathy, Constrictive Pericarditis, and Diastolic Dysfunction
In patients with Hypertrophic Cardiomyopathy (HCM), constrictive pericarditis, and diastolic dysfunction without edema, several symptoms might be expected. These symptoms can be attributed to the underlying conditions and their effects on the heart's functioning.
Common Symptoms
- Tiredness or fatigue 2
- Shortness of breath, especially with physical activity 2, 3
- Dizziness or light-headedness 2
- Chest pain (angina), which may worsen with physical exertion 2
- Palpitations, described as a fluttering or rapid heartbeat 2
- Dyspnea, a symptom of right-sided heart failure 3
Symptoms Related to Constrictive Pericarditis
- Fatigue 4
- Symptoms mimicking right-sided heart failure, such as dyspnea 3
- In some cases, patients might experience ascites and liver dysfunction, although these are more commonly associated with edema 4
Impact of Diastolic Dysfunction
- Exertional dyspnea 5
- Angina 5
- Collapse, in severe cases, due to diastolic dysfunction rather than systolic dysfunction 5
- Improved symptoms with calcium channel blockers, which enhance diastolic filling characteristics 5, 6
Summary of Expected Symptoms
Without edema, patients with HCM, constrictive pericarditis, and diastolic dysfunction may still experience a range of symptoms primarily related to the heart's impaired ability to fill and pump blood efficiently. These symptoms can significantly impact the patient's quality of life and physical capabilities.