Hypertrophic cardiomyopathy: Medical therapy
- Martin S Maron, MD
Martin S Maron, MD
- Assistant Professor of Medicine
- Tufts University School of Medicine
Hypertrophic cardiomyopathy (HCM) is a genetically determined heart muscle disease most often (60 to 70 percent) caused by mutations in one of several sarcomere genes which encode components of the contractile apparatus. (See "Hypertrophic cardiomyopathy: Gene mutations and clinical genetic testing".)
HCM is characterized by left ventricular hypertrophy (LVH) of various morphologies, with a wide array of clinical manifestations and hemodynamic abnormalities (figure 1). Depending in part upon the site and extent of cardiac hypertrophy, HCM patients can develop one or more of the following abnormalities:
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- GENERAL PRINCIPLES OF MEDICAL THERAPY IN HCM
- Mechanisms of action
- Approach to medical therapy
- Avoidance of volume depletion
- Medications to be avoided or used with caution
- Rate and rhythm control
- Endocarditis prophylaxis
- MEDICAL THERAPY FOR DIFFERENT HCM-RELATED PRESENTATIONS
- Heart failure
- - Beta blockers
- - Non-dihydropyridine calcium channel blockers
- - Disopyramide
- Limitations to treatment with disopyramide
- Chest pain
- Acute hemodynamic collapse in the setting of LVOT obstruction
- HCM during pregnancy and delivery
- End-stage disease
- PERIOPERATIVE MANAGEMENT DURING NON-CARDIAC SURGERY
- ASYMPTOMATIC PATIENTS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS