2020 Hypertrophic cardiomyopathy

 

Investigations

·         ECG (? Signs)

·         TTE (? LVH ? LVOTO)

·         Holter (? Arrhythmia)

·         MRI (if still unsure)

Treatment

Drugs:

·         B1 blocker

·         Cardiac-selective CCB

·         Disopyramide

AICD if:

·         Malignant arrhythmia

o   Arrest

o   Syncope

o   Sustained VT

·         At risk of malignant arrhythmia

o   Massive LVH >30mm

o   LV dysfunction

o   FHx SCD

Invasive:

·         Alcohol septal ablation

·         Myomectomy

Complicating factors

Ischaemia: do angiogram if

·         Symptoms

·         LV deterioration

·         Planning invasive treatment

AF:

·         Anticoagulate everyone

Pregnant:

·         Ante-natal counselling

·         MDT care

·         Continue beta blocker

·         If anticoagulated: use LMWH

Genetics

·         Patient: gene test

·         First degree relatives: gene test, periodic ECG and TTE

Follow up

·         TTE every 1-2 years, or if deteriorating

 

 

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