Hypertrophic cardiomyopathy activities and circumstances to avoid
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Editors-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
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[1][2]:
- 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. [3]
- 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 AHA/ACC Guidelines Recommendations- Participation in Competitive or Recreational Sports and Physical Activity (DO NOT EDIT)
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. (Level of Evidence: C)
Class IIa
1. (Level of Evidence: C)
2. (Level of Evidence: C)
References
- ↑ Braunwald E, Lambrew C, Rockoff D et al. Idiopathic hypertrophicsubaortic stenosis. I. a description of the disease based upon an analysis of 64 patients. Circulation 1964;30(Suppl IV):3–217.
- ↑ Kizilbash AM, Heinle SK, Grayburn PA. Spontaneous variability of left ventricular outflow tract gradient in hypertrophic obstructive cardiomyopathy. Circulation 1998;97:461–6.
- ↑ 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.