In HCM (hypertrophic cardiomyopathy), trouble eating a full meal is actually not uncommon, especially in people who have outflow tract obstruction (a “gradient”). A resting gradient of 37 mmHg is in the obstructive range, and this can explain some of the symptoms.

Why eating can make you feel sick:

Several things happen when someone with obstructive HCM eats a full meal:

1. Stomach fills → pushes up on the diaphragm → pushes on the heart.
When the heart is already thickened and the outflow tract is narrow, this pressure can worsen obstruction.

2. After eating, blood flow is directed to the gut.
This can temporarily reduce blood available to the heart and worsen lightheadedness, nausea, or near-fainting.

3. Full stomach increases vagal tone.
This can trigger nausea, dizziness, and even vomiting in people who already have borderline cardiac output.

4. If the person has arrhythmias, meals can sometimes trigger symptoms as well (especially tachycardias).

When this becomes concerning:

Unintentional weight loss of 28 pounds in a few months
→ This is significant and needs medical evaluation.
It may mean they simply can’t maintain intake because they feel too sick, but it also raises concern for:

Worsening obstruction.

New arrhythmias.

GI disorders unrelated to HCM.

Medication side effects (β-blockers, verapamil, disopyramide, etc.).

Helpful interim steps (NOT a substitute for seeing their cardiologist):

While waiting for the appointment:

1. Eat smaller, more frequent meals.
Avoid large dinners especially.

2. Avoid dehydration — even mild dehydration increases obstruction.

3. Avoid alcohol, caffeine, or heavy meals, which can worsen symptoms.

4. Check if your medications are optimized.
Beta-blockers or calcium channel blockers help many people by reducing the gradient.

5. Track symptoms:

Time of day.

What they ate.

Heart rate.

Whether symptoms come with exertion.

What the cardiologist may look at:

Updated echocardiogram with gradient at rest and with provocation

Whether they are a candidate for medication adjustment.

Whether they may benefit from Mavacamten (Camzyos) or a septal reduction therapy (alcohol ablation or surgical myectomy) if symptoms are severe.

Screening for arrhythmias (Holter or event monitor).

Screening for GI causes if symptoms don’t match cardiac patterns.

Bottom line:

Feeling sick or unable to eat full meals can happen in obstructive HCM, but losing 28 pounds is a warning sign that the gradient or overall heart function may need reevaluation. You are doing the right thing by seeing your cardiologist soon.