Which hemodynamic goals are important in managing hypertrophic cardiomyopathy?

In managing hypertrophic cardiomyopathy (HCM), one of the critical hemodynamic goals is to decrease contractility. HCM is characterized by a thickened ventricular wall, which can lead to outflow obstruction and increased myocardial oxygen demand. By decreasing contractility, the heart's force of contraction is reduced, which can help alleviate some of the symptoms and reduce the likelihood of obstruction during systole.

This decreased contractility can help lower the risk of arrhythmias and alleviate features of heart failure in these patients. It is particularly important to manage contractility when dealing with medications that influence heart function, such as beta-blockers and calcium channel blockers, as they specifically target this parameter.

The other options are less desirable in this context. Decreasing preload is often important in other cardiac conditions but may lead to decreased cardiac output in HCM. Increased afterload could exacerbate left ventricular outflow tract obstruction, and increased heart rate tends to worsen diastolic filling, which is essential for patients with HCM due to their relatively small ventricles. Thus, the strategy to decrease contractility aligns well with the overall management principles of hypertrophic cardiomyopathy.