Table 1. Other lifestyle considerations for patients with hypertrophic cardiomyopathy.

Reproduced and adapted from 2014 HCM ESC guidelines (Elliott et al. Eur Heart J. 2014;35 (39):2733–2779).¹

Topic	General guidance
Diet, alcohol and weight	Patients should be encouraged to maintain a healthy body mass index Large meals can precipitate chest pain, particularly in patients with LVOTO. Smaller, more frequent meals may be helpful Avoid dehydration and excess alcohol, particularly in patients with LVOTO Constipation is a frequent side-effect of verapamil/disopyramide and should be managed with diet and if necessary aperients
Smoking	There are no data that show an interaction between tobacco smoking and HCM, but patients should be provided with general advice on the health risks associated with smoking and, when available, information on smoking cessation
Sexual activity	Patients should be given the opportunity to discuss their concerns about sexual activity. Anxiety and depression following a diagnosis are frequent and some patients may express guilt or fear about their genetic diagnosis and the risk of transmission to offspring Patients should be counselled on the potential effect of their medication on sexual performance In general, patients should avoid phosphodiesterase type 5 (PDE5) inhibitors, particularly when they have LVOTO
Medication	Patients should be provided with information about their medication, including potential side-effects and interactions with prescribed medications, over-the-counter remedies and other complementary therapies Where possible, peripheral vasodilators should be avoided in patients, particularly when they have LVOTO
Vaccination	In the absence of contraindications, symptomatic patients should be advised to have yearly influenza vaccination
Driving	Most patients should be eligible for an ordinary driving licence and can continue driving unless they experience distracting or disabling symptoms Advice on driving licences for heavy goods or passenger-carrying vehicles should be in line with local legislation For further advice on driving with ICD see European Heart Rhythm Association guidelines and local rules.
Holidays and travel insurance
Education/schooling	Teachers and other carers should be provided with advice and written information relevant to the care of children with HCM In the absence of symptoms and risk factors, children should be allowed to perform low to moderate level aerobic physical activity, in accordance with advice from their cardiologist. Provision should be made for children with learning difficulties and other special needs