Ask the Experts HCM Guidelines: December Edition

"What is the Current Management Plan for a 53-Year-Old Female Patient With Hypertrophic Obstructive Cardiomyopathy With LVOT Gradient of 100 mmHg and No Symptoms?"

In general, the management of patients with hypertrophic cardiomyopathy (HCM) falls into 3 broad categories: a) family counseling, b) sudden cardiac death (SCD) risk assessment, c) management of symptoms. For most patients, even with LVOT obstruction, who are active and asymptomatic, there is no proven benefit to starting or titrating medications, nor is there a need to consider advanced therapies such as septal reduction therapy. If it is not clear that a patient is truly asymptomatic, then treadmill exercise testing to compare exercise capacity to age and sex-matched normal ranges can help identify patients who may be underperceiving their symptoms. For patients that do have normal exercise capacity, the usual recommendations are to stay hydrated, and live a healthy lifestyle.

References

  1. Ommen SR, Mital S, Burke MA, et al. 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2020 Dec 22;142(25):e558-e631. doi: 10.1161/CIR.0000000000000937. Epub 2020 Nov 20. Erratum in: Circulation. 2020 Dec 22;142(25):e633. PMID: 33215931.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, SCD/Ventricular Arrhythmias

Keywords: Cardiomyopathy, Hypertrophic, Death, Sudden, Cardiac, Healthy Lifestyle, Risk Assessment, Exercise Tolerance, Exercise Test, Reference Values


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