Page 12 - Heart Failure Clinical Guidelines

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IV. HYPERTROPHIC CARDIOMYOPATHY

A. Initial Evaluation for a Patient with Hypertrophic Cardiomyopathy

1. Additional Laboratories, Tests
MRI with contrast (evaluate function, fibrosis)

Laboratories
1. CK
2. Acyl Carnitine Profile
3. Urine Analysis with Micro
4. Urine Organic Acids
5. Serum Amino Acids
6. Hypertrophic Cardiomyopathy Gene Panel
Other Laboratories to Consider Based on History & Physical
1. Chromosomal Microarray

B. Long-Term Medical Management for Hypertrophic Cardiomyopathy

1. Beta Blockers
Indications
a) treatment of symptomatic left ventricular dysfunction
b) treatment of asymptomatic left ventricular dysfunction (EF<50% or SF<23%
c) treatment of dynamic left ventricular outflow tract obstruction or mid-cavitary gradient
d) treatment of restrictive physiology
e) treatment of tachycardia

2. Calcium Channel Blocker (Diltiazem or Verapamil)
Indications
a) treatment of dynamic left ventricular outflow tract obstruction
b) treatment of tachycardia

3. Anticoagulation
Indications
a) indwelling central venous catheter
b) previous thrombus or embolic event
c) persistent or uncontrolled atrial fibrillation or atrial flutter

4. AICD referral
a) family history of VT/Sudden Death in a relative with HCM
b) syncope
c) IVS >3.0cm
d) aborted sudden death
e) non-sustained ventricular tachycardia