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Medical Therapy: From Beta-Blockers to Disopyramide

  • Keith Mankowitz
  • Mark V. Sherrid
Chapter

Abstract

Hypertrophic cardiomyopathy (HCM) is a heterogeneous disease with a significant clinical variation requiring individualized treatment unique for each patient. Many patients can be managed conservatively with few or even no medications. The history, physical examination, and baseline echocardiogram usually determine the need for, type of, and titration of medications. Obstructive and nonobstructive patients are treated differently. Medications should be carefully titrated to manage each patient’s unique pathophysiology, particularly when there is LV outflow obstruction. Septal reduction therapy should generally only be considered once a patient has failed maximal medical treatment. Atrial fibrillation occurs in 25% of HCM patients and often is marked by a worsening of symptoms; it should be managed with rate control, attempts to maintain sinus rhythm and anticoagulation. This chapter also discusses the management of apical hypertrophic cardiomyopathy, hypertrophic cardiomyopathy associated with mid-ventricular obstruction, transformation into LV systolic dysfunction, and takotsubo cardiomyopathy in patients with HCM.

Keywords

Medical treatment Beta-blockers Disopyramide Verapamil Left ventricular outflow tract obstruction Diastolic heart failure Syncope Atrial fibrillation End-stage heart failure Apical hypertrophic cardiomyopathy Mid-ventricular obstruction 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Keith Mankowitz
    • 1
  • Mark V. Sherrid
    • 2
  1. 1.Department of Internal Medicine – CardiologySt Luke’s HospitalChesterfieldUSA
  2. 2.Leon Charney Division of CardiologyNew York University Langone Medical CenterNew York CityUSA

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