From the Research
The management approach for a patient with a sigmoid septum on echocardiogram should prioritize medical therapy as the first-line approach, with beta-blockers or non-dihydropyridine calcium channel blockers being the primary treatment options, as supported by the most recent study 1. The goal of treatment is to reduce contractility and heart rate, thereby decreasing outflow obstruction.
- For asymptomatic patients with incidental findings, observation with regular follow-up echocardiograms is appropriate.
- For patients with symptoms like chest pain, dyspnea, or syncope due to left ventricular outflow tract obstruction, medical therapy is the first-line approach.
- Beta-blockers (such as metoprolol 25-100 mg twice daily) or non-dihydropyridine calcium channel blockers (like verapamil 120-360 mg daily in divided doses) can be used to reduce contractility and heart rate, decreasing outflow obstruction.
- Patients should avoid dehydration, excessive alcohol, and vasodilators which may worsen symptoms.
- For patients with severe symptoms refractory to medical therapy, alternative treatments such as endocardial ablation 2 or surgical myectomy may be considered to reduce the septal bulge and relieve obstruction.
- Regular cardiology follow-up is essential to monitor for progression of obstruction and development of complications such as arrhythmias. It is also important to note that the combination of beta-blockers and ACE inhibitors may be beneficial in certain patients 3, but this should be tailored to individual patient needs and cardiovascular risk profile. Additionally, careful consideration should be given to the management of beta-blockers before exercise tests to avoid rebound phenomenon 4.