Hypertrophic cardiomyopathy primary prevention: Difference between revisions

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{{CMG}} {{AE}} {{Soroush}}
{{CMG}} {{AE}} {{Soroush}}
==Overview==
==Overview==
Any activity, drug or circumstance that increases left ventricular outflow obstruction, reduced left ventricular filling, or increases left ventricular afterload should be avoided.
There is no primary prevention for hypertrophic cardiomyopathy. This is a genetic familial disorder. But there are important approaches to decrease and prevent development of sudden death and heart attack in known cases of HCM (tertiary Prevention). Any activity, drug or circumstance that increases left ventricular outflow obstruction, reduced left ventricular filling, or increases left ventricular afterload should be avoided.


==Activities That Increase Left Ventricular Outflow Tract Obstruction==
==Activities That Increase Left Ventricular Outflow Tract Obstruction==
===Activities That Reduce Preload===
===Activities That Reduce Preload===
The following activities increase left ventricular outflow tract obstruction and should be avoided<ref>Braunwald E, Lambrew C, Rockoff D et al. Idiopathic hypertrophicsubaortic stenosis. I. a description of the disease based upon an
The following activities increase left ventricular outflow tract obstruction and should be avoided:
analysis of 64 patients. Circulation 1964;30(Suppl IV):3–217.</ref><ref>Kizilbash AM, Heinle SK, Grayburn PA. Spontaneous variability of left ventricular outflow tract gradient in hypertrophic obstructive
cardiomyopathy. Circulation 1998;97:461–6.</ref>:
*Nausea and vomiting
*Nausea and vomiting
*Dehydration
*Dehydration
*Hypovolemia (i.e., use diuretics with caution)
*Hypovolemia (i.e., use diuretics with caution)
*Medications that reduce preload and left ventricular filling such as nitrates
*Medications that reduce preload and left ventricular filling such as nitrates
*Alcohol ingestion may change outflow obstruction due to vaso and veno dilation. In one randomized trial, patients who ingested alcohol in amounts that mimic that ingested during  social circumstances sustained a rise in their gradient from 38 to 62 mm Hg, a drop in their systolic blood pressure from 132 to 122 mm Hg and an increase in systolic anterior motion (SAM) of the mitral valve. <ref>Paz R, Jortner R, Tunick PA et al. The effect of the ingestion of ethanol on obstruction of the left ventricular outflow tract in hypertrophic cardiomyopathy. N Engl J Med 1996;335:938–41.</ref>
*Alcohol ingestion may change outflow obstruction due to vaso and veno dilation. In one randomized trial, patients who ingested alcohol in amounts that mimic that ingested during  social circumstances sustained a rise in their gradient from 38 to 62 mm Hg, a drop in their systolic blood pressure from 132 to 122 mm Hg and an increase in systolic anterior motion (SAM) of the mitral valve.  
*Heavy meals may change the outflow obstruction for a wide variety of reasons including splanchnic pulling of blood
*Heavy meals may change the outflow obstruction for a wide variety of reasons including splanchnic pulling of blood


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*Intense isometric exercise (e.g., heavy weight lifting)
*Intense isometric exercise (e.g., heavy weight lifting)


==2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy (DO NOT EDIT)<ref name="pmid22075469">{{cite journal |author=Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW |title=2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=25 |pages=e212–60 |year=2011 |month=December |pmid=22075469 |doi=10.1016/j.jacc.2011.06.011 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02275-3 |accessdate=2011-12-19}}</ref>==
==2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy (DO NOT EDIT)==


===Participation in Competitive or Recreational Sports and Physical Activity (DO NOT EDIT)<ref name="pmid22075469">{{cite journal |author=Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW |title=2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=25 |pages=e212–60 |year=2011 |month=December |pmid=22075469 |doi=10.1016/j.jacc.2011.06.011 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02275-3 |accessdate=2011-12-19}}</ref>===
===Participation in Competitive or Recreational Sports and Physical Activity (DO NOT EDIT)<ref name="pmid22075469">{{cite journal |author=Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW |title=2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=25 |pages=e212–60 |year=2011 |month=December |pmid=22075469 |doi=10.1016/j.jacc.2011.06.011 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02275-3 |accessdate=2011-12-19}}</ref>===
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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' It is reasonable for patients with HCM to participate in low-intensity competitive sports (eg, golf and bowling)<ref name="pmid15837284">{{cite journal |author=Maron BJ, Ackerman MJ, Nishimura RA, Pyeritz RE, Towbin JA, Udelson JE |title=Task Force 4: HCM and other cardiomyopathies, mitral valve prolapse, myocarditis, and Marfan syndrome |journal=J. Am. Coll. Cardiol. |volume=45 |issue=8 |pages=1340–5 |year=2005 |month=April |pmid=15837284 |doi=10.1016/j.jacc.2005.02.011 |url=}}</ref><ref name="pmid15923204">{{cite journal |author=Pelliccia A, Fagard R, Bjørnstad HH, ''et al.'' |title=Recommendations for competitive sports participation in athletes with cardiovascular disease: a consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology |journal=Eur. Heart J. |volume=26 |issue=14 |pages=1422–45 |year=2005 |month=July |pmid=15923204 |doi=10.1093/eurheartj/ehi325 |url=}}</ref>. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' It is reasonable for patients with HCM to participate in low-intensity competitive sports (eg, golf and bowling). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' It is reasonable for patients with HCM to participate in a range of recreational sporting activities<ref name="pmid15184297">{{cite journal |author=Maron BJ, Chaitman BR, Ackerman MJ, ''et al.'' |title=Recommendations for physical activity and recreational sports participation for young patients with genetic cardiovascular diseases |journal=Circulation |volume=109 |issue=22 |pages=2807–16 |year=2004 |month=June |pmid=15184297 |doi=10.1161/01.CIR.0000128363.85581.E1 |url=}}</ref>. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' It is reasonable for patients with HCM to participate in a range of recreational sporting activities. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|}
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|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
|-
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Patients with HCM should not participate in intense competitive sports regardless of age, sex, race, presence or absence of LVOT obstruction, prior septal reduction therapy, or implantation of a cardioverter-defibrillator for high-risk status<ref name="pmid15837284">{{cite journal |author=Maron BJ, Ackerman MJ, Nishimura RA, Pyeritz RE, Towbin JA, Udelson JE |title=Task Force 4: HCM and other cardiomyopathies, mitral valve prolapse, myocarditis, and Marfan syndrome |journal=J. Am. Coll. Cardiol. |volume=45 |issue=8 |pages=1340–5 |year=2005 |month=April |pmid=15837284 |doi=10.1016/j.jacc.2005.02.011 |url=}}</ref><ref name="pmid15923204">{{cite journal |author=Pelliccia A, Fagard R, Bjørnstad HH, ''et al.'' |title=Recommendations for competitive sports participation in athletes with cardiovascular disease: a consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology |journal=Eur. Heart J. |volume=26 |issue=14 |pages=1422–45 |year=2005 |month=July |pmid=15923204 |doi=10.1093/eurheartj/ehi325 |url=}}</ref><ref name="pmid3510233">{{cite journal |author=Maron BJ, Epstein SE, Roberts WC |title=Causes of sudden death in competitive athletes |journal=J. Am. Coll. Cardiol. |volume=7 |issue=1 |pages=204–14 |year=1986 |month=January |pmid=3510233 |doi= |url=}}</ref><ref name="pmid12968091">{{cite journal |author=Maron BJ |title=Sudden death in young athletes |journal=N. Engl. J. Med. |volume=349 |issue=11 |pages=1064–75 |year=2003 |month=September |pmid=12968091 |doi=10.1056/NEJMra022783 |url=}}</ref><ref name="pmid12651044">{{cite journal |author=Maron BJ, Carney KP, Lever HM, ''et al.'' |title=Relationship of race to sudden cardiac death in competitive athletes with hypertrophic cardiomyopathy |journal=J. Am. Coll. Cardiol. |volume=41 |issue=6 |pages=974–80 |year=2003 |month=March |pmid=12651044 |doi= |url=}}</ref><ref name="pmid19221222">{{cite journal |author=Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO |title=Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980-2006 |journal=Circulation |volume=119 |issue=8 |pages=1085–92 |year=2009 |month=March |pmid=19221222 |doi=10.1161/CIRCULATIONAHA.108.804617 |url=}}</ref><ref name="pmid14662259">{{cite journal |author=Corrado D, Basso C, Rizzoli G, Schiavon M, Thiene G |title=Does sports activity enhance the risk of sudden death in adolescents and young adults? |journal=J. Am. Coll. Cardiol. |volume=42 |issue=11 |pages=1959–63 |year=2003 |month=December |pmid=14662259 |doi= |url=}}</ref>. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Patients with HCM should not participate in intense competitive sports regardless of age, sex, race, presence or absence of LVOT obstruction, prior septal reduction therapy, or implantation of a cardioverter-defibrillator for high-risk status<ref name="pmid15837284">{{cite journal |author=Maron BJ, Ackerman MJ, Nishimura RA, Pyeritz RE, Towbin JA, Udelson JE |title=Task Force 4: HCM and other cardiomyopathies, mitral valve prolapse, myocarditis, and Marfan syndrome |journal=J. Am. Coll. Cardiol. |volume=45 |issue=8 |pages=1340–5 |year=2005 |month=April |pmid=15837284 |doi=10.1016/j.jacc.2005.02.011 |url=}}</ref><ref name="pmid15923204">{{cite journal |author=Pelliccia A, Fagard R, Bjørnstad HH, ''et al.'' |title=Recommendations for competitive sports participation in athletes with cardiovascular disease: a consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology |journal=Eur. Heart J. |volume=26 |issue=14 |pages=1422–45 |year=2005 |month=July |pmid=15923204 |doi=10.1093/eurheartj/ehi325 |url=}}</ref>. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|}
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<references />

Revision as of 21:36, 7 January 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]

Overview

There is no primary prevention for hypertrophic cardiomyopathy. This is a genetic familial disorder. But there are important approaches to decrease and prevent development of sudden death and heart attack in known cases of HCM (tertiary Prevention). Any activity, drug or circumstance that increases left ventricular outflow obstruction, reduced left ventricular filling, or increases left ventricular afterload should be avoided.

Activities That Increase Left Ventricular Outflow Tract Obstruction

Activities That Reduce Preload

The following activities increase left ventricular outflow tract obstruction and should be avoided:

  • Nausea and vomiting
  • Dehydration
  • Hypovolemia (i.e., use diuretics with caution)
  • Medications that reduce preload and left ventricular filling such as nitrates
  • Alcohol ingestion may change outflow obstruction due to vaso and veno dilation. In one randomized trial, patients who ingested alcohol in amounts that mimic that ingested during social circumstances sustained a rise in their gradient from 38 to 62 mm Hg, a drop in their systolic blood pressure from 132 to 122 mm Hg and an increase in systolic anterior motion (SAM) of the mitral valve.
  • Heavy meals may change the outflow obstruction for a wide variety of reasons including splanchnic pulling of blood

Activities That Increase Afterload

The following activities increase left ventricular afterload should be avoided:

  • Competitive endurance training
  • Burst activities (e.g., sprinting)
  • Intense isometric exercise (e.g., heavy weight lifting)

2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy (DO NOT EDIT)

Participation in Competitive or Recreational Sports and Physical Activity (DO NOT EDIT)[1]

Class IIa
"1. It is reasonable for patients with HCM to participate in low-intensity competitive sports (eg, golf and bowling). (Level of Evidence: C) "
"2. It is reasonable for patients with HCM to participate in a range of recreational sporting activities. (Level of Evidence: C) "
Class III (Harm)
"1. Patients with HCM should not participate in intense competitive sports regardless of age, sex, race, presence or absence of LVOT obstruction, prior septal reduction therapy, or implantation of a cardioverter-defibrillator for high-risk status[2][3]. (Level of Evidence: C) "
  1. ↑ Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW (2011). "2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Journal of the American College of Cardiology. 58 (25): e212–60. doi:10.1016/j.jacc.2011.06.011. PMID 22075469. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  2. ↑ Maron BJ, Ackerman MJ, Nishimura RA, Pyeritz RE, Towbin JA, Udelson JE (2005). "Task Force 4: HCM and other cardiomyopathies, mitral valve prolapse, myocarditis, and Marfan syndrome". J. Am. Coll. Cardiol. 45 (8): 1340–5. doi:10.1016/j.jacc.2005.02.011. PMID 15837284. Unknown parameter |month= ignored (help)
  3. ↑ Pelliccia A, Fagard R, Bjørnstad HH; et al. (2005). "Recommendations for competitive sports participation in athletes with cardiovascular disease: a consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology". Eur. Heart J. 26 (14): 1422–45. doi:10.1093/eurheartj/ehi325. PMID 15923204. Unknown parameter |month= ignored (help)
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