Complications
Pregnancy and vaginal delivery are generally well tolerated in women with hypertrophic cardiomyopathy who are asymptomatic without significant left ventricular outflow tract obstruction (LVOTO).
Expert maternal/fetal medical specialist care is recommended for women on medical therapy as the drugs may have adverse effects in the fetus.
Expert maternal/fetal medical specialist care is also recommended for women who are symptomatic or have LVOTO >50 mmHg as symptoms may worsen due to changes in contractility, heart rate, and vascular resistance or venous capacitance that occur with pregnancy, labour, and/or delivery.[110][111]
Sudden cardiac death (SCD) is the most common mode of death in young people with hypertrophic cardiomyopathy (HCM), occurring with an incidence of 1% per year.[67] The proposed mechanism of SCD is ventricular tachycardia secondary to ischaemia.[4] SCD typically occurs in the setting of extreme exertion.
Risk factors for HCM sudden death include: younger age; non-sustained ventricular tachycardia on ambulatory monitor; abnormal BP response to exercise; massive hypertrophy (left ventricular wall thickness ≥30 mm); severe outflow obstruction on echocardiogram; family history of sudden death; personal history of unexplained syncope; prior cardiac arrest or sustained ventricular tachycardia; left ventricular systolic dysfunction with ejection fraction <50%; left atrial enlargement; presence of left ventricular apical aneurysm; diffuse and extensive late gadolinium enhancement by cardiac MRI.[1][2][40] Patients with HCM who survived a cardiac arrest and were treated with conventional medical therapy or surgery have been shown to have a 7-year mortality rate of 33%.[29]
The site of the vegetation is usually the thickened anterior mitral valve leaflet.
Hypertrophic cardiomyopathy no longer mandates antibiotic IE prophylaxis unless there is a history of prior endocarditis or prosthetic valve.
Atrial fibrillation in hypertrophic cardiomyopathy (HCM) significantly increases the risk of stroke caused by systemic emboli.[4]
Anticoagulation is recommended for patients with HCM and atrial fibrillation, with a direct oral anticoagulant (DOAC) first-line and a vitamin K antagonists (ususlly warfarin) second-line.[2]
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