Hypertrophic Cardiomyopathy with Exertional Chest Pain and No LVOTO — When Beta-Blockers or Calcium Antagonists Have Not Improved Symptoms

Clinical Scenario

Patients with hypertrophic cardiomyopathy who experience angina-like chest pain on exertion in the absence of left ventricular outflow tract obstruction (LVOTO).

Previous Line — Inadequate Response

Beta-blockers or calcium antagonists (verapamil or diltiazem) represent the initial approach to improving symptoms in this setting. When symptom improvement is not achieved, the protocol escalates to a further treatment option.

Next-Line Approach

An oral agent from a specific drug class may be considered to support symptom improvement in patients without LVOTO. The complete selection criteria, clinical context, and management pathway are available in the full protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/eurheartj/ehad194

Beta-blockers and calcium antagonists (verapamil or diltiazem) should be considered to improve symptoms in patients with angina-like chest pain even in the absence of LVOTO or obstructive CAD.

Oral nitrates may be considered to improve symptoms in patients with angina-like chest pain, even in the absence of obstructive CAD, if there is no LVOTO.

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