Clinical Treatment Guidelines for Hypertrophic Cardiomyopathy

Diagnostic Evaluation

• The American College of Cardiology recommends initial evaluation to include comprehensive physical examination, complete medical history, and 3-generation family history 2
• The American Heart Association suggests that transthoracic echocardiography (TTE) is recommended for initial diagnosis and assessment of degree of myocardial hypertrophy, dynamic left ventricular outflow tract obstruction (LVOTO), mitral regurgitation, and myocardial function 3
• For patients with no change in clinical status, the American College of Cardiology recommends repeat TTE every 1-2 years 3
• Cardiovascular magnetic resonance (CMR) imaging is indicated when echocardiography is inconclusive, or there is suspicion of alternative diagnoses, according to the American College of Cardiology 3 and the Journal of the American College of Cardiology 4

Management of Obstructive HCM

• The American College of Cardiology recommends beta-blockers as first-line therapy for patients with symptoms attributable to LVOTO 1
• The American Heart Association suggests non-dihydropyridine calcium channel blockers as second-line therapy for patients who do not respond to or cannot tolerate beta-blockers 1
• Verapamil should be used with caution in patients with high gradients, advanced heart failure, or sinus bradycardia, according to the Journal of the American College of Cardiology 4

Management of Nonobstructive HCM with Preserved EF

• The American College of Cardiology recommends beta-blockers or non-dihydropyridine calcium channel blockers for symptoms of exertional angina or dyspnea 5

Management of HCM with Advanced Heart Failure

• The American College of Cardiology recommends guideline-directed therapy for heart failure with reduced EF for patients who develop systolic dysfunction with LVEF <50% 6
• Diagnostic testing to assess for concomitant causes of systolic dysfunction is recommended by the American Heart Association 6

Management of Atrial Fibrillation

• The American College of Cardiology recommends anticoagulation with direct-acting oral anticoagulants or vitamin K antagonists for patients with clinical or subclinical AF >24 hours 5

Management of Ventricular Arrhythmias

• The American Heart Association suggests antiarrhythmic drug therapy for symptomatic ventricular arrhythmias or recurrent ICD shocks despite beta-blocker use 6
• Catheter ablation can be useful for recurrent symptomatic sustained monomorphic ventricular tachycardia or recurrent ICD shocks despite optimal drug therapy, according to the American College of Cardiology 6

Lifestyle Considerations

• The Journal of the American College of Cardiology recommends low-intensity aerobic exercise as part of a healthy lifestyle 4
• Comorbidities that may contribute to cardiovascular disease should be treated according to relevant guidelines, according to the Journal of the American College of Cardiology 4
• For pregnant women with HCM, vaginal delivery is recommended as the first-choice delivery option, according to the Journal of the American College of Cardiology 7