Date of Award

8-1-2020

Document Type

Restricted Access Thesis

Degree Name

MS in Physician Assistant Studies (PA)

Department

Physician Assistant Studies

First Advisor

Vanessa Bester, EdD, PA-C

Abstract

Background: Hypertrophic cardiomyopathy (HCM) is a genetic cardiac disease associated with high population prevalence and the potential for sudden cardiac death (SCD). Treating the disease is difficult, with symptom management, surgery, implantable cardioverter- defibrillator (ICD) therapy, and heart transplantation as the main options. This literature review outlines the history of the disease, the role genetics play in diagnosis and future treatment, and screening for families and athletes. A description of HCM with and without obstruction is provided. Additionally, a summary of the current risk stratification guidelines and an overview of treatment and ICD therapy is included.

Methods: This paper is a systematic review of 22 articles; it seeks to analyze ICD therapy recommendations for patient selection and timing based on the current risk stratification models; pointing out strengths and weaknesses. Key terms include "hypertrophic cardiomyopathy", "ICD therapy", "sudden cardiac death", "risk stratification guidelines", and "athlete screening".

Results: Analysis of current data identifies flaws in the current risk stratification guidelines. These include lack of research surrounding comorbid conditions and their impact on ICD therapy, lack of knowledge surrounding which risk factors are most predictive for SCD, and the role potential risk factors play in assessment. Included is a thorough comparison of the United States and European guidelines, and areas for future research. In addition, novel treatments are outlined. Conclusion: The current guidelines are ill-suited for clinical use, and a new algorithm is necessary to determine optimal timing for ICD therapy and to correctly identify qualifying patients.

Identifier

SC 11.PAS.2020.Marti.S

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