Managing Stroke Prevention in Hypertrophic Obstructive Cardiomyopathy (HOCM) Patients Without Confirmed Persistent Atrial Fibrillation: A Dilemma of Anticoagulation

Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic cardiovascular disorder characterized by the thickening of the heart muscle, particularly the left ventricle. It is a leading cause of sudden cardiac death in young individuals. HOCM is associated with various complications, including arrhythmias and an increased risk of stroke. Patients with HOCM are at an increased risk of stroke due to the development of atrial fibrillation (AFib), a common arrhythmia observed in HOCM. AFib can result in the formation of blood clots in the atria, which may subsequently embolize the brain, causing a stroke. However, not all HOCM patients develop persistent AFib, leading to uncertainty regarding the appropriate management of stroke prevention in these cases. This case study aims to explore the management of recurrent cerebrovascular events (CVA) in a patient with HOCM who does not have confirmed persistent AFib. The argument revolves around whether anticoagulation should be offered for secondary stroke prevention in HOCM patients without a confirmed diagnosis of persistent AFib.