Hypertrophic cardiomyopathy: symptom control and relief of obstruction
THE CONTEXT
Management includes symptom relief, treatment of arrhythmias, interventions for outflow obstruction and consideration of a defibrillator in patients with sudden-death risk factors.
Drug treatment
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Symptom and syncope control: Beta-blockers, rate-limiting calcium antagonists and disopyramide can relieve symptoms and prevent syncopal attacks.
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Mavacamten: This cardiac myosin inhibitor improves symptoms but requires special monitoring because it can cause left ventricular systolic impairment.
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Arrhythmias: These often respond to amiodarone.
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Prognosis: No pharmacological treatment has been identified that improves prognosis.
Procedures and device consideration
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Myectomy: Partial surgical resection can improve outflow tract obstruction.
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Septal ablation: A catheter-delivered alcohol solution produces iatrogenic infarction of the basal septum to improve outflow tract obstruction.
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Defibrillator consideration: An implantable cardioverter-defibrillator should be considered in patients with clinical risk factors for sudden death.
Drugs to avoid
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Digoxin and vasodilators: These may increase outflow tract obstruction and should be avoided.