Hypertrophic cardiomyopathy primary prevention
Hypertrophic Cardiomyopathy Microchapters
Hypertrophic cardiomyopathy primary prevention On the Web
There is no primary prevention for hypertrophic cardiomyopathy. This is a genetic familial disorder. But there are important approaches to decrease and prevent development of sudden death and heart attack in known cases of HCM (tertiary Prevention). 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 Increase Left Ventricular Outflow Tract Obstruction
Activities That Reduce Preload
- Nausea and vomiting
- 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 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)
Indications for implantable cardioverter-defibrillator (primary prevention)
- Family history of SCD
- Non sustained VT on Holter monitoring
- Syncope: recurrent or exercise-associated
- Hypotension during exercise
- Sever septal thickness (more than 3 cm)
2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy (DO NOT EDIT)
Participation in Competitive or Recreational Sports and Physical Activity (DO NOT EDIT)
|"1. It is reasonable for patients with HCM to participate in low-intensity competitive sports (eg, golf and bowling). (Level of Evidence: C) "|
|"2. It is reasonable for patients with HCM to participate in a range of recreational sporting activities. (Level of Evidence: C) "|
|Class III (Harm)|
|"1. Patients with HCM should not participate in intense competitive sports regardless of age, sex, race, presence or absence of LVOT obstruction, prior septal reduction therapy, or implantation of a cardioverter-defibrillator for high-risk status. (Level of Evidence: C) "|
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