Overview
Hypertrophic cardiomyopathy is characterized by abnormal myocardial hypertrophy, often involving the interventricular septum, with variable left ventricular outflow obstruction.
Clinical Features
Patients may have exertional dyspnea, chest pain, palpitations, presyncope, or syncope.
Some patients are identified after a family history of sudden cardiac death or through screening.
Examination
A systolic murmur related to dynamic outflow obstruction may increase with reduced ventricular preload and decrease with increased preload.
Maneuvers that reduce preload can intensify dynamic LV outflow obstruction.
Investigation & Management
Echocardiography and cardiac MRI characterize hypertrophy and obstruction. ECG and ambulatory monitoring are useful in risk assessment.
Management may include symptom control, prevention of sudden cardiac death, and septal reduction therapy in selected patients.
Clinical Pearls
In HCM, think about two major issues: dynamic outflow obstruction and ventricular arrhythmia risk.
END OF REVIEW
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