Review Article

A Narrative Review of the Pathophysiology and Treatment of Hypertrophic Cardiomyopathy

Authors: Lee M. Gelpi Acevedo, BSc, Alexandra Lizette Salinas, BSc, Juan Sebastian Polanco, BSc, LMT, Hamasah Nizami, MD, Denise Marsh, BSN, RN, Meet Patel, MBBS, Kinna Parikh, MBBS, Rahul Jain, MD, Rohit Jain, MD

Abstract

Hypertrophic cardiomyopathy (HCM) is a genetic autosomal dominant disorder of the heart muscle that is characterized by left ventricular hypertrophy and sudden cardiac death. It is the most common inherited cardiac disease. HCM is defined by sarcomeric mutations that result in fibrosis of the heart, affecting contraction. In most cases, clinical presentations can range from asymptomatic to systolic and diastolic ventricular dysfunction, arrhythmias, and sudden cardiac death. Some histopathologic features typical of the disease are changes in myocyte disarray and myocardial fibrosis. Mutations in the β-myosin heavy chain and myosin-binding protein C have been identified as the cause of the disease. The goals of pharmacological therapy as well as nonpharmacological therapy are to alleviate the symptoms and to prevent sudden cardiac death. Anatomical defects are treated primarily by surgical intervention, whereas other issues such as hypercontractility are treated with pharmacotherapy. In this article, we review the pathophysiology and treatment options for HCM.

 

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References

1. Basit H, Brito D, Sharma S. Hypertrophic Cardiomyopathy. Treasure Island, FL: StatPearls Publishing; 2022.
 
2. Liew AC, Vassiliou VS, Cooper R, et al. Hypertrophic cardiomyopathy— past, present and future. J Clin Med 2017;6:118.
 
3. Wolf CM. Hypertrophic cardiomyopathy: genetics and clinical perspectives. Cardiovasc Diagn Ther 2019;9(suppl 2):S388–S415.
 
4. Maron BJ, Rowin EJ, Maron MS. Global burden of hypertrophic cardiomyopathy. JACC Heart Fail 2018;6:376–378.
 
5. Gersh BJ, Maron BJ, Bonow RO, et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2011;58: 2703–2738.
 
6. Maron BJ, Ommen SR, Semsarian C, et al. Hypertrophic cardiomyopathy: present and future, with translation into contemporary cardiovascular medicine. J Am Coll Cardiol 2014;64:83–99.
 
7. Olivotto I, Maron MS, Adabag AS, et al. Gender-related differences in the clinical presentation and outcome of hypertrophic cardiomyopathy. J Am Coll Cardiol 2005;46:480–487.
 
8. Brown KN, Pendela VS, Ahmed I, et al. Restrictive Cardiomyopathy. Treasure Island, FL: StatPearls Publishing; 2022.
 
9. Jacoby DL, DePasquale EC, McKenna WJ. Hypertrophic cardiomyopathy: diagnosis, risk stratification and treatment. CMAJ 2013;185:127–134.
 
10. Antunes MO, Scudeler TL. Hypertrophic cardiomyopathy. Int J Cardiol Heart Vasc 2020;27:100503.
 
11. Díez-López C, Salazar-Mendiguchía J. Clinical presentations of hypertrophic cardiomyopathy and implications for therapy. Glob Cardiol Sci Pract 2018; 2018:19.
 
12. Jordà P, García-Álvarez A. Hypertrophic cardiomyopathy: sudden cardiac death risk stratification in adults. Glob Cardiol Sci Pract 2018;2018:25.
 
13. O’Mahony C, Elliott P, McKenna W. Sudden cardiac death in hypertrophic cardiomyopathy. Circ Arrhythm Electrophysiol 2013;6:443–451.
 
14. Maron BJ, Maron MS, Semsarian C. Genetics of hypertrophic cardiomyopathy after 20 years. J Am Coll Cardiol 2012;60:705–715.
 
15. Ingles J, Goldstein J, Thaxton C, et al. Evaluating the clinical validity of hypertrophic cardiomyopathy genes. Circ Genom Precis Med 2019;12: e002460.
 
16. Marian AJ. Molecular genetic basis of hypertrophic cardiomyopathy. Circ Res 2021;128:1533–1553.
 
17. Malhotra A, Sharma S. Hypertrophic cardiomyopathy in athletes. Eur Cardiol 2017;12:80–82.
 
18. Dunn KE, Caleshu C, Cirino AL, et al. A clinical approach to inherited hypertrophy. Circ Cardiovasc Genet 2013;6:118–131.
 
19. Marian AJ, Braunwald E. Hypertrophic cardiomyopathy: genetics, pathogenesis, clinical manifestations, diagnosis, and therapy. Circ Res 2017;121:749–770.
 
20. Wigle ED, Rakowski H, Kimball BP, et al. Hypertrophic cardiomyopathy. Circulation 1995;92:1680–1692.
 
21. Santamaría AZ, Aldana N, Gutiérrez C, et al. Left ventricular outflow tract obstruction. Obstrucción del tracto de salida del ventrículo izquierdo. Rev Colomb Radiol 2017;28:4609–4615.
 
22. Varma P, Neema P. Hypertrophic cardiomyopathy: part 1—introduction, pathology and pathophysiology. Ann Card Anaesth 2014;17:118–124.
 
23. Albakri A. Hypertrophic cardiomyopathy: a review of literature on clinical status and meta-analysis of diagnosis and clinical management methods. Clin Med Invest 2018;3:1–16.
 
24. Noureldin RA, Liu S, Nacif MS, et al. The diagnosis of hypertrophic cardiomyopathy by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2012;14:17.
 
25. Yang JH, Park SW, Yang JH, et al. Dynamic left ventricular outflow tract obstruction without basal septal hypertrophy, caused by catecholamine therapy and volume depletion. Korean J Intern Med 2008;23:106–109.
 
26. Houston BA, Stevens GR. Hypertrophic cardiomyopathy: a review. Clin Med Insights Cardiol 2014;8(suppl 1):53–65.
 
27. Wigle ED, Sasson Z, Henderson MA, et al. Hypertrophic cardiomyopathy. The importance of the site and the extent of hypertrophy. A review. Prog Cardiovasc Dis 1985;28:1–83.
 
28. Maron MS, Olivotto I, Maron BJ, et al. The case for myocardial ischemia in hypertrophic cardiomyopathy. J Am Coll Cardiol 2009;54:866–875.
 
29. Prinz C, Farr M, Hering D, et al. The diagnosis and treatment of hypertrophic cardiomyopathy. Dtsch Arztebl Int 2011;108:209–215.
 
30. Sundjaja JH, Makaryus AN. Disopyramide. Treasure Island, FL: StatPearls Publishing; 2022.
 
31. Dominguez F, Sanz-Sánchez J, García-Pavía P, et al. Follow-up and prognosis of HCM. Glob Cardiol Sci Pract 2018;2018:33.
 
32. Cassagnol M. Managing hypertrophic cardiomyopathy.https://www.uspharmacist.com/article/managing-hypertrophic-cardiomyopathy. Published May 17, 2016. Accessed March 22, 2022.