Hypertrophic cardiomyopathy activities and circumstances to avoid

Editors-In-Chief: C. Michael Gibson, M.S., M.D. [mailto:mgibson@perfuse.org]

Overview
Any activity, drug or circumstance that increases left ventricular outflow obstruction, reduced left ventricular filling, or increases left ventricular afterload should be avoided.

Activities That Reduce Preload
The following activities increase left ventricular outflow tract obstruction and should be avoided :
 * Nausea and vomiting
 * Dehydration
 * Hypovolemia (i.e., use diuretics with caution)
 * Medications that reduce preload and left ventricular filling such as nitrates
 * Alcohol ingestion may change outflow obstruction due to vaso and veno dilation. In one randomized trial, patients who ingested alcohol in amounts that mimic that ingested during social circumstances sustained a rise in their gradient from 38 to 62 mm Hg, a drop in their systolic blood pressure from 132 to 122 mm Hg and an increase in systolic anterior motion (SAM) of the mitral valve.
 * Heavy meals may change the outflow obstruction for a wide variety of reasons including splanchnic pulling of blood

Activities That Increase Afterload
The following activities increase left ventricular afterload should be avoided:
 * Competitive endurance training
 * Burst activities (e.g., sprinting)
 * Intense isometric exercise (e.g., heavy weight lifting)