What are the treatments for hypertrophic cardiomyopathy

The obvious feature of hypertrophic cardiomyopathy is the progressive thickening of the myocardium and the shrinkage of the ventricles. At present, the cause of this disease is unknown, but there are still many methods to help treat it, and the specific choice depends on the patient's condition.

1. General treatment

(1) Avoid strenuous physical activity or emotional excitement. Even patients who do not have obvious obstruction when resting may develop obstructive symptoms or worsen existing obstructive symptoms when they are emotionally excited or doing physical labor.

(2) Use drugs and measures to reduce the heart's preload and afterload with caution. This is different from other heart diseases, especially when heart failure occurs. Digitalis preparations and diuretics increase ventricular contractility and reduce blood volume, which can aggravate intraventricular obstruction. If there is atrial fibrillation with a rapid ventricular rate during heart failure, digitalis can be used.

2. Internal medicine drug treatment

(1) β-blockers are still the first choice for the treatment of HCM because the myocardium of patients with this disease is highly sensitive to catecholamines. β-blockers can block the effects of catecholamines, reduce myocardial contractility, and can also reduce left ventricular outflow tract obstruction by slowing down the heart rate, prolonging the ventricular diastolic filling period, increasing the diastolic filling volume, and preventing and treating arrhythmias. In addition, because beta-blockers can slow the heart rate, prolong diastolic ventricular filling, and reduce myocardial oxygen consumption through negative inotropic effects, they can effectively relieve patients' dyspnea and angina pectoris, improve exercise tolerance, and prevent the aggravation of outflow tract obstruction associated with exercise. They are especially suitable for obstructive HCM. According to data, beta-blockers can improve symptoms in 33% to 50% of patients. Propranolol (Inderal) has the longest history of use. It can be started at 30 mg/d and gradually increased to 120 mg/d, or until the resting ventricular rate is no less than 60 beats/min, which is the maximum effective dose. Maintaining use for 2 years often shows therapeutic effects. In recent years, metoprolol (25-100 mg/d) has also been used to reverse myocardial hypertrophy.

(2) Calcium channel blockers: They are important drugs for the treatment of symptomatic hypertrophic cardiomyopathy. The drug can selectively inhibit the influx of Ca2+ into the cell membrane, reduce the utilization of intracellular Ca2+ and the binding force between the cell membrane and Ca2+, reduce intracellular calcium overload, reduce the consumption of ATP in myocardial cells, interfere with excitation-contraction coupling, inhibit myocardial contraction, improve left ventricular diastolic function and the asynchrony of local wall motion, and reduce subendocardial myocardial ischemia, thereby helping to alleviate left ventricular outflow tract obstruction and reduce the left ventricular outflow tract pressure gradient. Long-term use can achieve good therapeutic effects.