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Chapter: Clinical Cases in Anesthesia : Hypertrophic Obstructive Cardiomyopathy

What are the treatment options for HOCM?

Medical therapy of HOCM is based on β-blockers (Table 8.1).

What are the treatment options for HOCM?

 

Medical therapy of HOCM is based on β-blockers (Table 8.1). Their beneficial effects are likely due to a depression of systolic function and an improvement in diastolic filling and relaxation. However, it is still not clear whether life expectancy is prolonged by this treatment. Amiodarone is a commonly used agent for the control of supraventricular and ventricular dysrhythmias.

 


Nonmedical treatment options are surgical myotomy/ myomectomy, percutaneous transluminal septal myo-cardial ablation, alcohol septal ablation, mitral valve replacement/valvuloplasty, or a combination of the former. The potential complications of surgical correction of the LVOT obstruction include complete heart block and late formation of a ventricular septal defect due to septal infarction.

 

Controlled studies did not confirm earlier reports that atrioventricular sequential (DDD) pacing is beneficial for patients with HOCM. Dual-chamber pacing can currently be recommended only in selected patients. The reported annual mortality rate is 1–3%, mostly due to ventricular dysrhythmias, sudden death, progressive heart failure, and atrial fibrillation with embolic stroke. There is accumulat-ing evidence that implantable automated defibrillator devices are highly effective in terminating malignant ventricular dysrhythmias in HOCM patients and, thus, decreasing the incidence of sudden death.

 

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Clinical Cases in Anesthesia : Hypertrophic Obstructive Cardiomyopathy : What are the treatment options for HOCM? |


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