Treatment strategies for hypertrophic cardiomyopathy based on anatomical variant

Hypertrophic cardiomyopathy (HCM) is the most common inherited heart disease and is characterized by a variety of manifestations: from morphological features and disease progression to clinical presentation and hemodynamic parameters. Management of HCM should be strictly individualized, considering not only hemodynamic parameters but also anatomical features. Classification based on the presence or absence of left ventricular outflow tract obstruction, as well as the location of interventricular septal hypertrophy (basal, midventricular, and apical), largely determines the optimal management strategy. Drug therapy, surgical myectomy, and alcohol septal ablation are the main treatment options for obstructive HCM, whereas management of the non-obstructive form focuses on symptom control and prevention of complications. Given the risk of sudden cardiac death, timely implantation of an implantable cardioverter-defibrillator in high-risk patients is of paramount importance.