Hypertrophic cardiomyopathy
ICD-10 I42.1 · ICD-11 BC43.1

Treatment of Hypertrophic Cardiomyopathy with Heart Failure (NYHA Class II–IV) and No Left Ventricular Outflow Obstruction

Clinical Scenario

Heart Failure · NYHA Class II–IV

This protocol applies to patients with hypertrophic cardiomyopathy who have symptomatic heart failure — NYHA functional class II through IV — in the absence of left ventricular outflow tract obstruction, and with a left ventricular ejection fraction of 50% or greater.

Management Approach

In this setting, management follows established heart failure guidelines. Drug therapy is directed at reducing ventricular diastolic pressures and improving filling through rate-slowing agents, alongside careful use of diuretics where needed.

The complete regimen — specific agents, selection criteria, and clinical sequencing — is available in the full protocol.
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References

DOI: 10.1093/eurheartj/ehad194

Management of heart failure in patients without LVOTO should follow the recommendations of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure, summarized in Section 6.10.2.

The aim of drug therapy is to reduce LV diastolic pressures and improve LV filling by slowing the heart rate with beta-blockers, verapamil, or diltiazem (ideally monitored by ambulatory ECG recording), and cautious use of loop diuretics.

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