Hypertrophic cardiomyopathy is a genetically determined cardiac disorder characterized by hypertrophy, often of the left ventricle (LV), with nondilated ventricular chambers and no other cardiac or systemic disease (eg aortic stenosis, thyroid disease or hypertension) capable of producing the extent of hypertrophy manifested by the patient.
Symptoms can range from patients being asymptomatic to mildly or significantly symptomatic with pre-syncopal or syncopal episodes, palpitations, chest pain, decreased exercise tolerance, symptoms of pulmonary congestion (eg fatigue, dyspnea, orthopnea and paroxysmal nocturnal dyspnea) and symptoms of end-stage heart failure.
Approach to treatment is based on clinical experience and observational data as large randomized trials regarding medical therapy in hypertrophic cardiomyopathy are lacking.
An empiric therapy is often necessary to identify the best possible drug for the patient, starting at a low dose and titrating until clinical improvement or occurrence of side effects.
Treat comorbidities such as hypertension, diabetes, obesity and hyperlipidemia according to existing guidelines due to the significant influence of concomitant coronary artery disease on the survival of patients with hypertrophic cardiomyopathy.
Treatment with finerenone led to significantly reduced risk of cardiovascular (CV) events in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D), regardless of their CV disease (CVD) history, according to the FIDELIO-DKD* trial presented at AHA 2020.