HOCM and Dynamic LVOTO Clinical Guide

When a stronger contraction can actually make cardiac output worse, understanding the physiology changes everything.

Hypertrophic obstructive cardiomyopathy (HOCM) can challenge even experienced clinicians because the obstruction is dynamic. Changes in preload, afterload, contractility, and heart rate can rapidly alter LV outflow tract obstruction—and a treatment that seems appropriate for hypotension may actually worsen the patient's hemodynamics.

The Acute Care Atlas HOCM Clinical Guide breaks this complex physiology into practical bedside concepts clinicians can recognize and apply.

Inside, you’ll explore septal hypertrophy, dynamic LVOT obstruction, systolic anterior motion (SAM), mitral regurgitation, echo findings, acute hypotension, arrhythmias, chronic therapy, and bedside management principles—with an emphasis on understanding why the patient is deteriorating rather than simply reacting to the blood pressure.

Inside the Guide

• HCM vs obstructive HCM
• The “more squeeze → more obstruction” paradox
• Preload, afterload, contractility & heart-rate effects
• SAM and associated mitral regurgitation
• Recognizing dynamic LVOTO at the bedside
• Key echocardiographic findings and LVOT gradients
• Acute hypotension and hemodynamic management
• Common interventions that can worsen obstruction
• Beta-blockers, calcium-channel blockers and advanced therapies
• Cardiac myosin inhibition, including mavacamten
• Atrial fibrillation and the importance of diastolic filling
• Sudden cardiac death considerations
• A practical HOCM hypotension bedside framework
• Clinical pearls, safety considerations and current references

Designed for: acute-care NPs and PAs, ICU and cardiology nurses, critical-care clinicians, APP fellows, cardiac-surgery clinicians, and anyone who wants to understand the physiology behind HOCM rather than simply memorize treatment rules.

The bedside pearl to remember:

More squeeze → more obstruction → less forward flow.

Recognize the physiology. Understand the paradox. Treat the patient.

The Acute Care Atlas

Practical Clinical Guides for Complex Care

© 2026 Tina Chaphe. The Acute Care Atlas. All rights reserved.