Drug Therapy for Hypertrophic Cardiomypathy: Physiology and Practice

Current Cardiology Reviews
Mark V Sherrid

Abstract

HCM is the most common inherited heart condition occurring in 1:500 individuals in the general population. Left ventricular outflow obstruction at rest or after provocation occurs in 2/3 of HCM patients and is a frequent cause of limiting symptoms. Pharmacologic therapy is the first-line treatment for obstruction, and should be aggressively pursued before application of invasive therapy. Beta-blockade is given first, and up-titrated to decrease resting heart rate to between 50 and 60 beats per minute. However, beta-blockade is not expected to decrease resting gradients; its effect rests on decreasing the rise in gradient that accompanies exercise. For patients who fail beta-blockade the addition of oral disopyramide in adequate dose often will decrease resting gradients and offer meaningful relief of symptoms. Disopyramide vagolytic side effects, if they occur, can be greatly mitigated by simultaneous administration of oral pyridostigmine. This combination allows adequate dosing of disopyramide to achieve therapeutic goals. Verapamil utility in obstructive HCM with high resting gradients is limited by its vasodilating effects that can, infrequently, worsen gradient and symptoms. As such, we tend to avoid it in patients with hig...Continue Reading

Citations

Dec 13, 2017·Expert Review of Cardiovascular Therapy·Luis F HidalgoWilbert S Aronow
Jul 11, 2020·Anales de pediatría : publicación oficial de la Asociación Española de Pediatría (A.E.P.)·Moisés Rodriguez-GonzalezHelena María Cascales-Poyatos

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Methods Mentioned

BETA
pharmacotherapy

Clinical Trials Mentioned

NCT02291237
NCT01912534

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