The current method of diagnosing hypertrophic obstructive cardiomyopathy is based mainly on echocardiography and cardiac nuclear magnetic decision of diagnosis, both of which can initially determine the degree, location, and degree of obstruction of myocardial hypertrophy, but can underestimate the real degree of obstruction that exists, this is because the contraction of the myocardium can be increased during exercise and increase the degree of outflow tract obstruction, so exercise or drugs secondary to it may be closer to the real degree of obstruction, which is valuable for determining the patient’s risk and the choice of treatment can be very valuable. But what is the final choice of treatment? Drugs? Intervention? or surgery? Does the patient respond well to the medication primarily? If drug therapy is not effective in controlling outflow tract pressure, it is very important to receive further treatment (interventional or surgical) to reduce the risk of sudden death and clinical symptoms in patients. Shijie You, Department of Cardiovascular Medicine, Fu Wai Hospital, Beijing, China
The choice of interventional therapy is based on the patient’s clinical symptoms of outflow tract obstruction and the presence of real outflow tract obstruction, and the possibility of interventional therapy can only be considered if the pressure exceeds 50 mmHg at rest or 70 mmHg during exercise or drug provocation. In some patients, although the criteria for intervention are met, surgical treatment may be the best option if there is no intervention available, i.e., if there is no good coronary artery distribution at the site of obstruction or if the distribution is extensive.