Management of Hypertrophic Obstructive Cardiomyopathy with Concurrent Hypertension and Intracerebral Haemorrhage: A Case Report

Abstract

Hypertrophic Obstructive Cardiomyopathy (HOCM) is primarily a hereditary genetic disorder that presents difficulties in managing hypertension using a wide range of antihypertensive medications. It is crucial to steer clear of any substance that reduces preload or afterload in this situation, making beta-adrenergic receptor antagonists the ideal option. Hereby is a case of a 41-year-old who reported to the Medicine Outpatient Department (OPD) with complaints of weakness in the right upper and lower limbs for two days and altered sensorium. The patient was recently diagnosed with hypertension, and a Computed Tomography (CT) scan showed a left gangliocapsular bleed with a 3 mm midline shift. Echocardiography revealed HOCM. The patient was started on antioedema drugs and metoprolol. A repeat CT scan showed a decrease in the size of the bleed and surrounding oedema. The patient’s consciousness improved, and blood pressure came under control. He was discharged with antihypertensives for regular follow-ups. Overall, this case underscores the complex interplay between HOCM and hypertension, the challenges in managing hypertension in HOCM patients, and the critical role of beta-adrenergic receptor antagonists in this setting. It highlights the need for a tailored approach to hypertension management and the importance of early recognition and appropriate intervention in patients with HOCM presenting with complications such as intracranial haemorrhage.

Keywords

• hypertrophic cardiomyopathy
• intracraial bleed
• metoprolol