Disopyramide in HCM – Cardiology MCQ – Answer

Disopyramide is a class Ia antiarrhythmic agent which can be used in hypertrophic obstructive cardiomyopathy when beta blockers alone are ineffective. Pick out the WRONG statement regarding disopyramide in this context:

Correct answer: c) Should not be combined with verapamil

Disopyramide has a negative inotropic action and is useful in reducing left ventricular outflow tract gradients in hypertrophic obstructive cardiomyopathy and does not increase the risk of sudden cardiac death. Dose reduction is recommended when QTc exceeds 480 ms. It should be avoided in those with glaucoma and men with prostatic symptoms in view of its anticholinergic action. Anticholinergic action is responsible for increase in ventricular rate with atrial fibrillation. It can be combined with verapamil.

An important downside is that it is not available in most countries! Anticholinergic symptoms like dryness of mouth and eyes, urinary hesitancy or retention and constipation may limit the dose up titration.

Reference

1. Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P, Hagege AA, Lafont A, Limongelli G, Mahrholdt H, McKenna WJ, Mogensen J, Nihoyannopoulos P, Nistri S, Pieper PG, Pieske B, Rapezzi C, Rutten FH, Tillmanns C, Watkins H. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J. 2014 Oct 14;35(39):2733-79.

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