Hypertrophic cardiomyopathy resident survival guide
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Steven Bellm, M.D. [2]
| Hypertrophic cardiomyopathy resident survival guide Microchapters |
|---|
| Overview |
| Classification |
| Causes |
| Diagnosis |
| Treatment |
| Do's |
| Dont's |
Overview
Hypertrophic Cardiomyopathy is defined by LV hypertrophy associated with nondilated ventricular chambers without any other cardiac or systemic disease that itself would be capable of producing the magnitude of hypertrophy evident. HCM is usually recognized by maximal LV wall thickness ≥15 mm. Wall thickness of 13 to 14 mm is considered borderline if there are other compelling information (eg, family history of HCM), based on echocardiography. The diagnostic imaging mainly focused on echocardiography, however cardiovascular magnetic resonance (CMR) is used with increasing frequency.[1]
Classification
| Left Ventricular Hypertrophy | |||||||||||||||||||||||||||||||||
| Sarcomere Mutation | Without Extracardiac or Metabolic Findings + Genetic Substrate Unresolved | With Extracardiac or Metabolic Findings Associated With or Without Mutant Gene | |||||||||||||||||||||||||||||||
| Hypertrophic Cardiomyopathy | Syndrome with Left Ventricular Hypertrophy | ||||||||||||||||||||||||||||||||
Causes
Life Threatening Causes
Common Causes
Complete Diagnostic Approach
| A01 | |||||||||||||||||||||||||||||||||
| B01 | B02 | ||||||||||||||||||||||||||||||||
| C01 | |||||||||||||||||||||||||||||||||
| D01 | D02 | D03 | |||||||||||||||||||||||||||||||
| E01 | E02 | E03 | |||||||||||||||||||||||||||||||
| F01 | F02 | ||||||||||||||||||||||||||||||||
Treatment
| Patients with HCM | |||||||||||||||||||||||||||||||||||||||||||||||
| Treat comorbidities according to guidelines (hypertension, diabetes mellitus,etc) | |||||||||||||||||||||||||||||||||||||||||||||||
| Obstructive physiology? | |||||||||||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||
| Avoid vasodilator therapy and high-dose diuretics | Heart failure symptoms or angina | ||||||||||||||||||||||||||||||||||||||||||||||
| Heart failure symptoms or angina | Yes | No | |||||||||||||||||||||||||||||||||||||||||||||
| No | Yes | Systolic function? | Annual clinical evaluation | ||||||||||||||||||||||||||||||||||||||||||||
| Annual clinical evaluation | Beta-blockade/Verapamil/Disopyramide | LV-EF<50 percent | LV-EF≥50 percent | ||||||||||||||||||||||||||||||||||||||||||||
| Persistent symptoms | Therapy as described in Heart failure | Beta-blockade | Verapamil | ||||||||||||||||||||||||||||||||||||||||||||
| Invasive therapy | |||||||||||||||||||||||||||||||||||||||||||||||
| Acceptable surgical candidate | Diuretics | ACE inhibitor or ARB | |||||||||||||||||||||||||||||||||||||||||||||
| {{{. }}} | |||||||||||||||||||||||||||||||||||||||||||||||
| No | Yes | ||||||||||||||||||||||||||||||||||||||||||||||
| Acceptable candidate for alcohol ablation? | Alcohol ablation | Surgical myectomy | |||||||||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||
| Consider Alcohol ablation | Consider DDD pacing | ||||||||||||||||||||||||||||||||||||||||||||||
Based on the ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy.[2]
Do's
Dont's
References
- ↑ American College of Cardiology Foundation/American Heart Association Task Force on Practice. American Association for Thoracic Surgery. American Society of Echocardiography. American Society of Nuclear Cardiology. Heart Failure Society of America. Heart Rhythm Society; et al. (2011). "2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". J Thorac Cardiovasc Surg. 142 (6): e153–203. doi:10.1016/j.jtcvs.2011.10.020. PMID 22093723.
- ↑ Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS; et al. (2011). "2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. 124 (24): 2761–96. doi:10.1161/CIR.0b013e318223e230. PMID 22068435.