Implantable cardioverter defibrillators in the context of hypertrophic cardiomyopathy: a lesson in patient autonomy

BMJ Case Rep. 2018 Feb 5:2018:bcr2017223352. doi: 10.1136/bcr-2017-223352.

Abstract

Hypertrophiccardiomyopathy (HCM) is common, whereas the decision not to have an implantable cardioverterdefibrillator (ICD) when probably falling into a 'high-risk' category is not. A solicitor aged 45 years attended the inherited cardiac conditions clinic for review of her HCM and discussion about ICD implantation for primary prevention of sudden cardiac death (SCD). Despite a predicted 7% risk of SCD within the next 5 years, according to the European Society of Cardiology endorsed HCM Risk-SCD risk stratification tool, the patient opted against implantation of an ICD and comprehensively justifies her decision. This report discusses ethical aspects of a consultation offering ICD protection against SCD in the context of HCM and emphasises the clinicians' role in respecting patient autonomy.

Keywords: cardiovascular medicine; ethics.

Publication types

  • Case Reports

MeSH terms

  • Cardiomyopathy, Hypertrophic / complications
  • Cardiomyopathy, Hypertrophic / physiopathology*
  • Comprehension
  • Death, Sudden, Cardiac / prevention & control*
  • Decision Making
  • Defibrillators, Implantable*
  • Female
  • Humans
  • Informed Consent*
  • Middle Aged
  • Personal Autonomy*
  • Primary Prevention
  • Risk Factors
  • Treatment Refusal*