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In hypertrophic cardiomyopathy (HCM), the muscular heart walls (septum) are much thicker (hypertrophied) than those in a typical heart. The thickening can occur anywhere in the left lower heart chamber (left ventricle).
A number of conditions can cause shortness of breath and fast, pounding heartbeats. It's important to get a prompt, accurate diagnosis and appropriate care. See your health care provider if you have a family history of HCM or any symptoms associated with hypertrophic cardiomyopathy.
Hypertrophic cardiomyopathy typically affects the muscular wall (septum) between the two bottom chambers of the heart (ventricles). The thickened wall might block blood flow out of the heart. This is called obstructive hypertrophic cardiomyopathy.
If there's no significant blocking of blood flow, the condition is called nonobstructive hypertrophic cardiomyopathy. However, the heart's main pumping chamber (left ventricle) might stiffen. This makes it hard for the heart to relax and reduces the amount of blood the ventricle can hold and send to the body with each heartbeat.
Hypertrophic cardiomyopathy is usually passed down through families (inherited). People with one parent with hypertrophic cardiomyopathy have a 50% chance of having the genetic mutation for the disease.
If genetic testing isn't done, or if the results aren't helpful, then a health care provider might recommend repeated echocardiograms if you have a family member with hypertrophic cardiomyopathy. Adolescents and competitive athletes should be screened once a year. Adults who don't compete in athletics should be screened every five years.
Normally, a small wound to the top layer of your skin heals nicely. New skin forms as the wound heals. With deeper wounds (into the dermis layer and lower), your body responds by making collagen to repair the wound. Collagen is thicker than the rest of your skin. This thicker, less flexible tissue becomes a scar. Most scars are flat. However, sometimes your body makes extra collagen that results in a raised scar. This type of raised scar can be either a hypertrophic scar or a keloid.
The key visible difference between hypertrophic and keloid scars is the degree of the spread of the scar around the original wound. With hypertrophic scars, the extra connective tissue that forms within the original wound stays within that area. With keloid scars, the extra connective tissue that forms extends beyond the original wound area. This and other differences between these two raised scars are shown in the table.
Hypertrophic scars that result from burn wounds are more difficult to treat. Superficial burn wounds usually heal without forming hypertrophic scars. Deep burn wounds are harder to treat. Many dermatologic and plastic surgeons treat these by removing the burned area and then using a skin graft.
If you know that you are prone to forming hypertrophic scars, you might want to avoid elective surgeries. Be sure to bring this up with your doctor during any consultation. Correction of any vitamin deficiencies such as Vitamin D prior to any elective surgery may also be helpful.
If you have a wound injury or an incision wound following surgery, always follow the wound care instructions given to you by your doctor. These instructions will tell you how to clean and care for your wound to promote healing and prevent scarring. Let your provider know if you are prone to scarring so they can more closely follow you in case you need treatment for a hypertrophic scar. Keep your follow-up appointments so your provider can check on how well your wound is healing.
Hypertrophic scarring represents an undesirable variant in the wound healing process. In hypertrophic scars, excess connective tissue is deposited in the area of the original tissue wound. This activity reviews the evaluation and management of hypertrophic scarring and highlights the role of the interprofessional team in the recognition and management of this condition.
Hypertrophic scarring represents an undesirable variant in the wound healing process. Another variant of wound healing, the keloid scar, is often used interchangeably with hypertrophic scarring, but this is incorrect. The excess connective tissue deposited in hypertrophic scarring is restricted to the area within the original wound. The excess connective tissue deposited in the keloid, however, extends beyond the area of the original wound. This article will review both of these entities in detail.
A variety of risk factors are linked to both hypertrophic scars and keloids. A very important, common, risk factor in clinical practice is tension on the wound. Hypertrophic scars and keloid scars often develop on areas of the body that undergo the most skin tension. These include the back, chest, and upper arms, or the occurrence of any scar over a bony or soft-tissue prominence. In contrast, hypertrophic scars rarely develop in areas with little skin tension such as the upper eyelids. In patients prone to keloid development, however, keloid can develop with any scar.
Certain systemic factors can increase the risk of hypertrophic scars. One study showed that hypertension is associated with increased keloid severity. Another systemic risk factor is inflammation. Systemic inflammation is seen after burn injuries further increasing the risk of developing hypertrophic scars and keloids for up to 1 year.
Multiple episodes of trauma to the same area are also a risk factor for hypertrophic scarring and keloid scars. One example is the use of earrings. Each time a person puts on or takes off the earing there can be some amount of trauma to the area. The site of ear piercings is a common area for the development of keloids, and there is an unclear association with nickel or other metals commonly used in ear jewelry. Burn wounds are prone to hypertrophic scarring, especially if they affect the deeper dermis (second and third-degree burns). One study found that hypertrophic scarring was much more likely in burn wounds that took three weeks or more to heal. Infection is another risk factor for hypertrophic and keloid scars. In addition, genetics can play a role in hypertrophic scars or keloids. Certain single-nucleotide polymorphisms are associated with keloid scars in persons of Japanese descent.
Adolescents and pregnant women may be more likely to form hypertrophic scars. People with darker skin complexions are about 15% more likely to develop keloid scars, and the lowest incidence of hypertrophic scars is in persons with albinism. It is estimated that 70% of deep (full thickness), burn injuries result in hypertrophic scars.
Although there is a defined clinical distinction between hypertrophic scars and keloid scars, these two disorders may lie within a spectrum of the same pathophysiologic process. The precise mechanisms distinguishing the two remain elusive. Wound healing is divided into three phases (inflammatory, proliferative, remodeling). The scar is formed in the last phase (remodeling phase).
There are increased numbers of myofibroblasts in hypertrophic scars. Transforming growth factor-beta (TGF-beta) stimulates differentiation of both local and bone fibroblasts into myofibroblasts, which then creates tension on the wound. It is hypothesized that existing tension on a wound may exacerbate this pathway, creating a vicious cycle. Certain pro-inflammatory mediators are unregulated in keloid scars. These include tumor necrosis factor-alpha, interleukin-1 alpha, interleukin-1 beta, and interleukin-6. Some experts believe that these mediators are more prominent in response to trauma in patients predisposed to hypertrophic and keloid scarring.
Burn wounds can be divided into superficial (partial thickness) and deep (full thickness). The majority of partial-thickness burn wounds heal without hypertrophic scarring. Deep wounds stimulate dermal fibroblasts to produce collagen and inflammatory mediators like transforming growth factor-beta 1 (TGF-beta1). TGF-beta1 further stimulates fibroblasts to deposit elastin and collagen, potentially leading to increased deposition in wounds predisposed to hypertrophic scarring. Over-expression of TGF-beta has been implicated in keloid scarring also, though the expression levels in hypertrophic scars and keloid scars remains a matter of ongoing investigation. .
Hypertrophic scarring presents as an area of increased induration and often dyspigmentation over the site of a wound, especially in areas of increased wound tension. Keloids present as marked hypertrophy of dermal tissue and they often feature dyspigmentation. As mentioned above, keloid scars extend beyond the margin of the original wound, as this is the defining feature to distinguish them clinically from hypertrophic scars. Hypertrophic scars and keloid scars also differ in the time it takes for them to develop, especially after burn injury. Hypertrophic scars develop in 1 to 2 months after injury, whereas, keloids develop months to years after the initial injury.
The diagnosis is usually made clinically. However, if a hypertrophic scar or keloid continues to worsen or change a biopsy may be necessary. Hypertrophic scars remain within the boundaries defined by the original defect/wound. Keloid scars extend beyond the original wound. There is a theoretical increased risk of malignant transformation in keloid scars not seen as frequently in hypertrophic scars 
Reducing tension on the wound with good surgical technique is an important aspect of prevention of hypertrophic scars during surgery. Patients who are known to form hypertrophic scars or keloids should avoid elective surgical procedures.
Once the hypertrophic scar or keloid scar has formed there are a variety of treatment modalities that may be used. Corticosteroid injection is a mainstay of therapy for hypertrophic scars. Surgical excision may be used to treat hypertrophic scars or keloid scars. However, in the case of keloid scars, surgical excision should not be used alone but rather in combination with another modality such as corticosteroid injection or radiotherapy. Radiotherapy has been shown to treat and prevent keloid scars. Laser therapy including long-pulsed Nd:YAG laser or pulsed dye laser have proven benefit in treating hypertrophic scars. These lasers target blood vessels and therefore are very helpful in reducing the color changes seen in hypertrophic scars. Cryotherapy may be used to treat hypertrophic or keloid scars. Although one would assume that a destructive treatment such as cryotherapy would induce scars, experts believe that a different collection of inflammatory mediators are released in response to cold injury compared to other types of injury such as burn injury. 5-Fluorouracil has successfully treated and prevented keloids. 2b1af7f3a8