40
Treatment
9.2. Occupation in Patients With HCM
COR LOE
Recommendations
2a C-EO
1. For patients with HCM, it is reasonable to follow Federal
Motor Carrier Safety Administration cardiovascular disease
guidelines that permit driving commercial motor vehicles, if
they do not have an ICD or any major risk factors for SCD
and are using a GDMT plan.
2a C-EO
2. For pilot aircrew with a diagnosis of HCM, it is reasonable to
follow Federal Aviation Administration guidelines that permit
consideration of multicrew flying duties, provided they are
asymptomatic, are deemed low risk for SCD, and can complete
a maximal treadmill stress test at 85% peak heart rate.
2b C-EO
3. It is reasonable for patients with HCM to consider
occupations that require manual labor, heavy lifting, or a high
level of physical performance after a comprehensive clinical
evaluation, risk stratification for SCD, and implementation
of GDMT in the context of shared decision-making.
9.3. Pregnancy in Patients With HCM
COR LOE
Recommendations
1 B-NR
1. For pregnant women with HCM and AF or other indications
for anticoagulation, low-molecular-weight heparin or vitamin
K antagonists (at maximum therapeutic dose of <5 mg daily)
are recommended for stroke prevention.
1 C-LD
2. In pregnant women with HCM, selected beta blockers
should be administered for symptoms related to outflow tract
obstruction or arrhythmias, with monitoring of fetal growth.
1 C-LD
3. In most pregnant women with HCM, vaginal delivery is
recommended as the first-choice delivery option.
1 B-NR
4. In affected families with HCM, preconceptional and prenatal
reproductive and genetic counseling should be offered.
1 C-EO
5. For pregnant women with HCM, care should be coordinated
between their cardiologist and an obstetrician. For patients
with HCM who are deemed high risk, consultation is advised
with an expert in maternal-fetal medicine.
2a C-LD
6. For women with clinically stable HCM who wish to become
pregnant, it is reasonable to advise that pregnancy is generally
safe as part of a shared discussion regarding potential
maternal and fetal risks, and initiation of GDMT.
2a C-LD
7. In pregnant women with HCM, cardioversion for new or
recurrent AF, particularly if symptomatic, is reasonable.
