Severe symptoms in non-obstructive HCM (hypertrophy myocard iomyopathy)may actually be more difficult to treat because there is no obvious target (obstruction) to treat. Obstruction would involve fluid dynamics, pressure gradients involving the mitral valve and output tract.
For a perspectivwe, depending on whether the distortion of normal heart anatomy causes an obstruction of the outflow of blood from the left ventricle of the heart: " HCM can be defined as obstructive or non-obstructive. The obstructive variant of HCM, Hypertrophic obstructive cardiomyopathy (HOCM) has also historically been known as idiopathic hypertrophic subaortic stenosis (IHSS) and asymmetric septal hypertrophy (ASH). Another, non-obstructive variant of HCM is apical hypertrophic cardiomyopathy ], first described in individuals of Japanese descent)".
Severe symptoms in non-obstructive HCM may actually be more difficult to treat because there is no obvious target (obstruction) to treat. Medical therapy with verapamil and beta-blockade may improve symptoms. Diuretics should be avoided, as they reduce the intravascular volume of blood, decreasing the amount of blood available to distend the left ventricular outflow tract, leading to an increase in the obstruction to the outflow of blood in the left ventricle.
Patients without LVOT obstruction constitute the majority of patients with hypertrophic cardiomyopathy. In these patients, β-blockers or calcium channel blockers (verapamil or diltiazem) can be used to optimize heart rate, leading to inherent improvements in myocyte relaxation and cardiac filling, and possibly a reduction in myocardial ischemia.
Beta blockers helps stablize the heart rate and reduces the heart's workload
Calcium channel blockers fall into one of two categories. Some of them affect the contractile strength of the heart, while others are vasodilators that cause arteries to relax and widen. Calcium channel blockers may be prescribed for people with high blood pressure (hypertension). They also reduce the workload of the heart, so they may be prescribed for hypertrophic cardiomyopathy.
Other conditions that may be treated by these medications include coronary artery disease, certain abnormal heart rhythms (arrhythmias) and history of a specific type of heart attack