From the Guidelines
Phenylephrine is not a primary treatment for hypertrophic cardiomyopathy (HCM) and should be used with caution due to its potential to worsen left ventricular outflow tract obstruction. In the management of HCM, the primary goal is to relieve symptoms and prevent complications, with a focus on reducing morbidity, mortality, and improving quality of life. According to the 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy 1, nonvasodilating beta-blockers are considered first-line therapy, followed by calcium channel blockers such as verapamil or diltiazem as reasonable alternatives. The use of phenylephrine, an alpha-1 adrenergic agonist, is generally avoided in HCM patients due to its vasoconstrictive effects, which can increase afterload and worsen left ventricular outflow tract obstruction. However, in acute settings where vasopressors are needed for HCM patients with hypotension, phenylephrine might be used with caution under close monitoring, as suggested by the 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM guideline for perioperative cardiovascular management for noncardiac surgery 1. Key considerations in the management of HCM include:
- Avoiding hypovolemia and reduced preload, which can worsen LVOT obstruction
- Avoiding hypotension and reduced afterload, which can worsen LVOT obstruction
- Avoiding tachycardia to ensure adequate LV filling
- Prioritizing intravenous fluid administration to correct hypovolemia if hypotension develops
- Considering the use of alpha-agonists, such as phenylephrine or vasopressin, with caution and close monitoring. Overall, the management of HCM requires a careful and individualized approach, with a focus on relieving symptoms, preventing complications, and improving quality of life, as supported by the latest guidelines 1.
From the Research
Treatment of Hypertrophic Cardiomyopathy (HCM)
- HCM is a genetic cardiac disease characterized by increased left ventricular wall thickness, which can lead to complications such as arrhythmias, heart failure, and sudden death 2, 3, 4.
- The treatment of HCM includes pharmacological therapies, such as beta-blockers, calcium channel blockers, disopyramide, and cardiac myosin inhibitors, as well as septal reduction therapies, including alcohol septal ablation and surgical myectomy 2, 3, 4, 5.
Role of Phenylnephrine in HCM
- There is no direct evidence in the provided studies on the role of phenylnephrine in the treatment of HCM.
- However, the studies discuss the use of various pharmacological agents, including beta-blockers, calcium channel blockers, and disopyramide, in the management of HCM symptoms and complications 3, 5, 6.
Management of HCM Symptoms and Complications
- The management of HCM symptoms and complications requires a personalized and tailored approach, taking into account the patient's phenotype, risk stratification, and individual preferences and needs 4.
- The treatment strategies for HCM include drug therapy, septal reduction therapies, and prevention of sudden death using implantable cardioverter-defibrillators 2, 3, 5, 6.