Oral disopyramide for the acute treatment of severe outflow obstruction in hypertrophic cardiomyopathy in the ICU setting
Abstract
When severe COPD and obstructive hypertrophic cardiomyopathy (HCM) coexist, management is challenging and complex. Drug contraindications limit pharmacologic options. Patients may not be candidates for surgical septal myectomy due to severe pulmonary disease. We describe a case of an elderly woman with severe reactive COPD who presented with an infectious exacerbation and dyspnea that progressed to near intubation due to heart failure from coexistent obstructive HCM. Transthoracic echocardiography revealed massive asymmetric septal hypertrophy and a diffusely hyperkinetic left ventricle with a left ventricular outflow tract (LVOT) gradient of 92 mm Hg. Two and a half hours after oral administration of disopyramide, LVOT gradient had decreased to 25 mm Hg with a corresponding immediate improvement in symptoms.
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Disopyramide reduces left ventricular outflow gradient and improves symptoms in patients with hypertrophic cardiomyopathy.
“has been shown to reduce LV outflow gradient and improve symptoms in patients with hypertrophic cardiomyopathy.[662][663][664]”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [663]
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Self-citation
- Authors
- Sirak, T. E., & Sherrid, M. V.
- Affiliations
- St. Luke's-Roosevelt Hospital Center (US)
- Corresponding author
- Sherrid, Mark V.
- ORCID
- Sherrid, Mark V.
- Venue
- Chest
- Publisher
- Elsevier BV
- Published
- 2008-05
- Volume
- 133
- Issue
- 5
- Pages
- 1243-1246
- ISSN
- 0012-3692 (ISSN-L)
- OpenAlex
- W2167242447
- Cited by
- 13
- References
- 20
- Citations by year
- 2025: 3 · 2024: 2 · 2018: 1 · 2017: 1 · 2016: 4 · 2013: 1
- FWCI
- 0.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- CHEST Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiomyopathy and Myosin Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Takotsubo Cardiomyopathy and Associated Phenomena
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Pulmonary Hypertension Research and Treatments
- Keywords
- disopyramide, hypertrophic cardiomyopathy, left ventricular outflow tract obstruction, COPD exacerbations, heart failure, septal hypertrophy, oral antiarrhythmic therapy, elderly patients, intensive care unit
- MeSH terms
- Administration, Oral, Anti-Arrhythmia Agents, Cardiomyopathy, Hypertrophic, Disopyramide, Dose-Response Relationship, Drug, Electrocardiography, Female, Follow-Up Studies, Humans, Intensive Care Units, Middle Aged, Ventricular Outflow Obstruction, Echocardiography, Doppler, Ventricular Function, Left, Pulmonary Disease, Chronic Obstructive
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