Hypertrophic cardiomyopathy medical therapy

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

Overview
The medical management of the patient with hypertrophic cardiomyopathy involves minimizing diastolic dysfunction, reducing left ventricular outflow tract obstruction, optimizing heart failure management, maintaining normal sinus rhythm, rate control and anticoagulation in the presence of atrial fibrillation, and implantation of an automatic implantable cardiac defibrillator in those patients who survive sudden cardiac death.

One of the funadamental goals of treatment is to relieve disabling dyspnea and improve exercise tolerance. It should be noted that the majority of patients do not have outflow tract obstruction, and therefore would not benefit from surgery. Medical therapy is therefore a mainstay of treatment. Given the limited number of patients with the condition, there are few randomized trials comparing strategies / agents in the management of HCM.

Initiation of Medical Therapy
Medical therapy is usually first initiated when signs and symptoms of exercise intolerance develop.

Diuretics
Treatment with diuretics (a mainstay of CHF treatment) will exacerbate symptoms in hypertrophic cardiomyopathy by decreasing ventricular volume and increasing outflow resistance.