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Old 08-11-2012
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Heart HOCM and beta blockers

do we give beta blocker in patient dxed with HOCM on routine physical examination ? [asymptomatic patient ]
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Old 08-11-2012
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Originally Posted by tyagee View Post
do we give beta blocker in patient dxed with HOCM on routine physical examination ? [asymptomatic patient ]
Yes, you always treat these patients to prevent SCD even if asymptomatic.
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Old 08-11-2012
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Originally Posted by Novobiocin View Post
Yes, you always treat these patients to prevent SCD even if asymptomatic.
you can also give CCB (verapamil and dialtazem)
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Old 08-11-2012
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Yes, you always treat these patients to prevent SCD even if asymptomatic.
frm utd


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because the impact of pharmacologic therapy on the natural history of HCM in asymptomatic patients is not known, routine prophylactic drug therapy is not recommended prior to the onset of symptoms. However, some experts suggest the use of beta blockers in patients with certain high-risk features (eg, severe hypertrophy or LV outflow obstruction) even if they are asymptomatic.
so ?
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Old 08-11-2012
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frm utd

so ?
There won't be a question like this on real exam since it is controversial.
If it is there, then the answer is--give BB.
The reason why there is a controversy becuase there are two varieties of HOCM--obstructive and non-obstructive and the BB are useful in the first but not the latter. There are many other reasons but we don't need to go into those details (best left for Cardiology Boards).
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Beta Blockers increase the filling time-> meaning more blood -> increase size of the chamber-> less obstruction-> less symptoms

HOCM murmur is decreased when the size of the chamber is increased as it decreases the murmur: leg rising
Murmur increases with less blood in the heart: valsalva, sudden standing up.

BB increase the filling time, decrease the need of more oxygen, so in the long term could slow the hypertrophy=obstruction.

If you think about mechanisms it makes sense to give BB.
Plus most of the boards literature suggest the use of BB

Last edited by LatinGeorge; 08-11-2012 at 07:25 PM.
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BB increase the filling time, decrease the need of more oxygen, so in the long term could slow the hypertrophy=obstruction.
Unlike HCM (due to Hypertension etc) HOCM is due to a genetic defect (AD) leading to sarcomere as well as myocyte alignment abnormality which cannot be prevented by BB. BB only help in decreasing myocardial O2 demand as well increasing the filling time in diastole therby decreasing the obstruction to the outflow. This decreases chances of Sudden Cardiac Death (SCD).
In high risk patients implantable cardioverter defibrillator (ICD) is the best option.
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