Approach to symptoms caused by obstruction in patients with hypertrophic cardiomyopathy*

CCB: calcium channel blocker; HCM: hypertrophic cardiomyopathy; LVOT: left ventricular outflow tract gradient.

* In patients with HCM, obstruction is defined as evidence of an LVOT gradient ≥30 mmHg and systolic anterior motion of the mitral valve at rest or with exercise. After starting medical therapy, patients may respond within 6 to 12 months.

¶ We prefer initial treatment with a beta blocker. For patients who cannot tolerate a beta blocker or who do not respond, we typically treat with a nondihydropyridine CCB. For information on doses and titration, refer to UpToDate content on the treatment of patients with obstructive HCM.

Δ The adverse effects and monitoring required for disopyramide and mavacamten therapy are described in UpToDate content on the treatment of obstructive HCM.

◊ Patients who proceed with septal reduction therapy (ie, surgical myectomy, alcohol septal ablation) typically have an LVOT gradient ≥50 mmHg. For the risks and benefits of these therapies, refer to UpToDate content on the treatment of patients with obstructive HCM.