Pharmacological Therapy
Medications are given to patients with hypertrophic cardiomyopathy to improve symptoms and prevent complications. In patients with left ventricular outflow tract obstruction some medications are not recommended as they could potentially increase the obstruction, so consult your doctor.
Beta-blockers
They are among the most prescribed drugs in patients with hypertrophic cardiomyopathy. They are used to reduce the contraction force of the heart and slow down the heart rate; this leads to a reduction in obstruction and improves the filling capacity. They can cause asthma (rarely), fatigue, excessive reduction in heart rate or reduction in blood pressure.
The main beta-blockers used are: bisoprolol (Cardicor, Congescor, Sequacor, etc), atenolol (Seles Beta, Tenormin, etc), metoprolol (Lopresor, Seloken, etc), nadolol (Corgard), propranolol (Inderal), etc..
Calcium channel blockers
They have a similar action to beta-blockers, leading to reduced heart contraction force and slower heart rate, reducing obstruction and improving heart filling. They are not associated with asthma, but like beta-blockers, they can cause excessive reduction in heart rate and/or blood pressure; some are associated with constipation. Caution should be used in prescribing calcium channel blockers in patients with severe left ventricular outflow tract obstruction as they can cause sudden breathlessness (dyspnea, pulmonary edema).
The main calcium channel blockers are: verapamil (Isoptin, Precordil, Quasar, etc) and diltiazem (Altiazem, Angizem, Dilzene, Tildiem, etc).
Disopyramide
It is an anti-arrhythmic drug that also has the property of reducing cardiac contraction and can be used in combination with beta-blockers or calcium channel blockers to reduce left ventricular outflow tract obstruction. It should be administered with electrocardiographic monitoring. It may be associated with dry mouth, dry eyes, urinary retention (in males with prostatic hypertrophy), ocular hypertension in patients with narrow angle glaucoma and worsening of severe myasthenia (rare neuro-muscular disease).
The trade name is Ritmodan.
Diuretics
These drugs facilitate the elimination of fluids by the kidneys and can be prescribed (often in combination with other drugs) in patients with breathlessness (dyspnea) due to accumulation of fluids and in some subjects with hypertension. They should be used with caution and with monitoring of renal function and electrolytes.
The main diuretics are: hydrochlorothiazide (Esidrex), hydrochlorothiazide and amiloride (Moduretic), furosemide (Lasix), torasemide (Diuremid, Diuresix, Toradiur, etc), spironolactone (Aldactone, Spirolang, etc), eplerenone (Inspra), potassium canreonate (Kanrenol, Luvion, etc), metolazone (Zaroxolyn).
Anti-arrhythmic drugs
They can be prescribed in patients with arrhythmias originating from the upper part of the heart (the atria) such as atrial fibrillation, or sometimes from the lower part of the heart (the ventricles), to control symptoms and prevent complications. The most commonly used drug is amiodarone (Amiodar, Cordarone), very effective, but also associated with several side effects such as hypersensitivity to the sun (so it is advisable to use sunscreen), changes in thyroid and liver function (which should be checked regularly) and, rarely, damage to the lungs. Another drug used is sotolol (Rhythm Beta, Sotalex), which is a beta-blocker with other anti-arrhythmic properties.
Oral anticoagulants
They are used to make the blood more fluid and are recommended in patients with a risk of thrombus (blood clots) forming in the heart, such as patients with atrial fibrillation. Anticoagulant drugs should be used with caution as they expose to the risk of bleeding. Some people need to monitor how much blood is scoagulated by means of a blood sample called INR, which must be performed periodically (usually every 1/2/4 weeks as appropriate.
The main oral anticoagulant drugs are: warfarin (Coumadin), acenocoumarol (Sintrom), dabigatran (Pradaxa), rivaroxaban (Xarelto), apixiban (Eliquis), edoxaban (Lixiana).
