Q. why diuretics are C/I in HOCM? - USMLE Forums
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Old 08-27-2016
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Default Q. why diuretics are C/I in HOCM?

Q. Why diuretics are contraindicated in Hypertrophic obstructive cardiomyopathy?
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Old 08-27-2016
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A diuretic is very similar in mechanism to valsalva maneuver.

During Valsalva there is decreased venous return to the right side of the heart (due to elevation of intra-thoracic pressures) and hence decreased filling of the left ventricle. An underfilled left ventricle results in an increase in LVOT obstruction as the ventricular cavity is smaller and the septum and mitral leaflets are closer in proximity, leading to narrowing of the LVOT in systole (Cleveland clinic).

Diuretics work in the same way --> they decrease the preload to the left side of the heart, leading to a smaller LV chamber, therefore worsening the murmur.

hope this helps
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diuretics , decrease blood ... = less blood in heart = more approximation of the outflow tract = narrower = more decrease in cardiac out put

thats why its avoided .,,,
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Old 08-29-2016
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Thanks Maymed & Dr. Hiba for the clear-cut explanation.
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Old 08-29-2016
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avoid any thing which will decrease pre load. also same thing happnes when hr increases
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Old 08-29-2016
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Hey Jyoti, can u explain what u mean to say- "same thing happens when HR increases".Do u mean to say, when HR inc, cardiac output decreases and as a result preload also decrease, OR u have any other meaning?
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