IHSS: Treatment

According to Barash, IHSS (HoCM) treatments include :

• alcohol ablation of the interventricular septum
• Pacing, using mode DDD with a short AV delay. This pre-excites the LV apex, resulting in paradoxical septal motion. The result is decreased ejection velocity, no SAM, and reduced LVOT gradient.
• septal myomectomy

Goals include :

• myocardial depression, often with volatiles
• preload full, afterload increased (e.g. phenylephrine)
• rate normal, rhythm sinus