Management strategies in hypertrophic cardiomyopathy: influence of age andmorphology

Management in hypertrophic cardiomyopathy is aimed at improving symptoms an d exercise capacity and preventing complications. particularly sudden death . The strategy for management of symptoms is to identify potentially import ant mechanisms at which treatment can be targeted. Assessment is feasible w ith non-invasive evaluation. All patients with hypertrophic cardiomyopathy should undergo risk assessment for sudden death. regardless of their sympto matic. morphological and haemodynamic status. Recent prospective studies ha ve examined five risk markers: family history of sudden death (two or more members aged < 45 years). unexplained syncope, non-sustained ventricular ta chycardia on Hotter monitoring, abnormal exercise blood pressure response a nd severe left ventricular hypertrophy (greater than or equal to3 cm). The majority of patients had none of these risk factors and did not die suddenl y. Annual sudden death rates were at least 2% among patients with two or mo re of these risk markers. which warrants consideration of prophylactic trea tment (amiodarone, implantable cardioverter-defibrillator) in such patients . (C) 2001 The European Society of Cardiology.