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[Syncope in hypertrophic (obstructive) cardiomyopathy]

Hubert Seggewiß1, Angelika Koljaja-Batzner2, Kornelia Seggewiß

  • 1Standort Juliusspital, Medizinische Klinik - Kardiologie & Internistische Intensivmedizin, Klinikum Würzburg-Mitte, Juliuspromenade 19, 97070, Würzburg, Deutschland. seggewiss.hubert@t-online.de.

Herzschrittmachertherapie & Elektrophysiologie
|May 16, 2018
PubMed

Insights

Hypertrophic cardiomyopathy, a genetic heart condition, often causes left ventricle outflow obstruction and sudden cardiac death risk. Diagnosis involves detailed syncope history and risk stratification for interventions like ICD implantation.

Area of Science:

  • Cardiology
  • Genetics
  • Cardiac Electrophysiology

Background:

  • Hypertrophic cardiomyopathy (HCM) is the most prevalent genetic cardiac disease.
  • Dynamic left ventricular outflow tract obstruction affects approximately 70% of HCM patients.
  • Younger patients with HCM face an elevated risk of sudden cardiac death.

Purpose of the Study:

  • To outline diagnostic and therapeutic strategies for hypertrophic cardiomyopathy.
  • To emphasize the importance of evaluating syncope etiology in HCM patients.
  • To discuss risk stratification for sudden cardiac death and symptomatic management.

Main Methods:

  • Detailed patient history focusing on syncope circumstances to differentiate rhythmogenic and hemodynamic causes.
  • Prognostic assessment for sudden cardiac death risk, guiding decisions on implantable cardioverter-defibrillator (ICD) implantation.
  • Symptomatic therapy evaluation, including medical management and interventional options.

Main Results:

  • Syncope and presyncope are common symptoms in HCM, alongside dyspnea and angina.
  • Distinguishing between rhythmogenic and hemodynamic causes of syncope is crucial for diagnosis.
  • Risk stratification is essential for identifying patients who may benefit from ICDs.

Conclusions:

  • HCM management requires a comprehensive approach, integrating diagnosis, risk assessment, and tailored therapy.
  • Medical therapy with beta-blockers and/or verapamil is the first line for symptomatic treatment.
  • Percutaneous septal ablation and surgical myectomy are effective complementary options for refractory symptoms in HCM.

Keywords:
Heart diseasesMyectomyObstruction left ventriclePercutaneous septal ablationSudden cardiac death

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