Hypertrophic cardiomyopathy

Last reviewed: 21 Apr 2022
Last updated: 18 Nov 2021

Summary

Definition

History and exam

Key diagnostic factors

  • family history of HCM
  • history of pre-syncope or syncope
  • systolic ejection murmur
  • left ventricular lift
  • double apical impulse or double carotid pulsation
  • family history of sudden death
More key diagnostic factors

Other diagnostic factors

  • younger male (<50 years)
  • dyspnoea
  • angina
  • palpitations
  • irregularly irregular pulse
  • older female (>50 years)
  • collapse
  • fourth heart sound
Other diagnostic factors

Risk factors

  • family history of HCM or sudden cardiac death
More risk factors

Diagnostic investigations

1st investigations to order

  • ECG
  • CXR
  • echocardiography
More 1st investigations to order

Investigations to consider

  • exercise ECG
  • Holter monitoring
  • nuclear imaging exercise test
  • CT coronary arteriography
  • cardiac catheterisation
  • cardiac MRI
  • genetic mutation analysis
More investigations to consider

Treatment algorithm

INITIAL

asymptomatic

ACUTE

symptomatic: predominant left ventricular (LV) outflow tract obstruction with preserved systolic function

symptomatic: predominant non-obstructive with preserved systolic function

ONGOING

symptomatic: end-stage heart failure with systolic dysfunction

Contributors

Authors

Monica Mukherjee, MD, MPH

Associate Professor of Medicine

Division of Cardiology

Johns Hopkins University School of Medicine

Baltimore

MD

Disclosures

MM declares that she has no competing interests.

Theodore Abraham, MD

Professor of Medicine and Radiology

Meyer Friedman Distinguished Professor of Medicine

Co-director, UCSF HCM Center of Excellence

University of California

San Francisco

CA

Disclosures

TA declares that he has no competing interests.

Acknowledgements

Dr Monica Mukherjee and Dr Theodore Abraham would like to gratefully acknowledge Dr Melanie D. Everitt and Dr Anji T. Yetman, previous contributors to this topic.

Disclosures

MDE and ATY declare that they have no competing interests.

Peer reviewers

Radhika Kuna, MD

Fellow

Division of Cardiology

University of Maryland Medical Center

Baltimore

MD

Disclosures

RK declares that she has no competing interests.

Saidi Mohiddin, BSc, MBChB

Consultant Cardiologist/Head of Unit

Heart Muscle Disease Unit

Barts and The London NHS Trust

London

UK

Disclosures

SM declares that he has no competing interests.

  • Hypertrophic cardiomyopathy images
  • Differentials

    • Athlete's heart
    • Discrete subaortic stenosis
    • LVH due to hypertension
    More Differentials
  • Guidelines

    • 2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy
    • 2020 ESC guidelines on sports cardiology and exercise in patients with cardiovascular disease
    More Guidelines
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer