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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