What is the recommended treatment for myocardial ischemia in HCM patients?

In patients with hypertrophic cardiomyopathy (HCM), the recommended treatment for managing myocardial ischemia is the use of beta-blockers. This class of medication works by reducing heart rate and myocardial contractility, which decreases the demand for oxygen by the heart muscle. This is particularly beneficial in HCM where left ventricular outflow obstruction can lead to ischemia due to the increased workload on the heart.

Beta-blockers improve coronary perfusion by allowing for longer diastolic filling times, thus enhancing blood flow to the myocardial tissue, which can alleviate ischemic symptoms such as chest pain or discomfort during exertion. Additionally, beta-blockers can help prevent arrhythmias, which are a common concern in patients with HCM.

Other therapies mentioned, like diuretics, ACE inhibitors, and anticoagulants, play different roles in the context of cardiovascular treatment but are not primarily aimed at addressing myocardial ischemia specifically within the population of HCM patients. Therefore, beta-blockers are the first-line treatment for myocardial ischemia in these patients, focusing on optimizing heart function and improving quality of life.