Acta clinica Croatica, Vol. 39 No. 4, 2000.
Conference paper
Hypertrophic Cardiomyopathy: How to Treat Patients at Risk?
Dubravko Petrač
Abstract
Hypertrophic cardiomyopathy is a primary cardiac muscle disease with clinical manifestations that vary from a benign asymptomatic course to severe heart failure or cardiac arrest. Therefore, the identification of individual risk of sudden cardiac death is the first step in the treatment of patients with hypertrophic cardiomyopathy. The factors that best identify high risk patients include a history of cardiac arrest or syncope, inducible sustained ventricular tachyarrhythmia, nonsustained ventricular tachycardia in symptomatic patients, presence of ischemia associated with hypotension in children, and presence of mutations in the beta-myosin heavy chain along with family history of sudden cardiac death. The treatment of patients with hypertrophic cardiomyopathy depends on the symptoms and risk degree. Patients with cardiac arrest, sustained ventricular tachycardia, or inducible sustained ventricular tachyarrhythmia during programmed ventricular stimulation have an indication for implantable cardioverter-defibrillator. Patients with the symptoms of impaired consciousness and nonsustained ventricular tachycardia without inducible sustained ventricular tachyarrhythmias can be treated with amiodarone. Asymptomatic patients with nonsustained ventricular tachycardia do not need prophylactic drug therapy, because their prognosis is the same as the prognosis of asymptomatic patients without such tachycardia. Asymptomatic patients with two or more risk factors are candidates for electrophysiological testing and subsequent pharmacological or nonpharmacological therapy. On the other hand, asymptomatic patients free from risk factors have a good prognosis and should be allowed to lead a normal life. However, in young asymptomatic patients or athletes, discontinuation of competitive, high- and medium-grade physical activity is mandatory, because this measure significantly reduces their risk of sudden cardiac death.
Keywords
Cardiomyopathy, hypertrophic, complications; Cardiomyopathy, hypertrophic, therapy; Death, sudden, cardiac; Risk factors
Hrčak ID:
14982
URI
Publication date:
1.12.2000.
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