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Oral Disopyramide for the Acute Treatment of Severe Outflow Obstruction in Hypertrophic Cardiomyopathy in the ICU Setting^*

^* From the Division of Cardiology, Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University, College of Physicians and Surgeons, New York, NY.

Correspondence to: Mark V. Sherrid, MD, Division of Cardiology, Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University, College of Physicians and Surgeons, 1000 Tenth Ave, 3B-30, New York, NY 10019; e-mail: msherrid{at}chpnet.org

When severe COPD and obstructive hypertrophic cardiomyopathy (HCM) coexist, management is challenging and complex. Drug contraindications limit pharmacologic options. Patients may not be candidates for surgical septal myectomy due to severe pulmonary disease. We describe a case of an elderly woman with severe reactive COPD who presented with an infectious exacerbation and dyspnea that progressed to near intubation due to heart failure from coexistent obstructive HCM. Transthoracic echocardiography revealed massive asymmetric septal hypertrophy and a diffusely hyperkinetic left ventricle with a left ventricular outflow tract (LVOT) gradient of 92 mm Hg. Two and a half hours after oral administration of disopyramide, LVOT gradient had decreased to 25 mm Hg with a corresponding immediate improvement in symptoms.

Key Words: asthma • COPD • disopyramide • hypertrophic cardiomyopathy • ICU • severe outflow obstruction