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Hypertrophic cardiomyopathy

Last reviewed: 10 Nov 2024
Last updated: 21 Mar 2024

Summary

Definition

History and exam

Key diagnostic factors

  • family history of HCM
  • history of presyncope or syncope
  • systolic ejection murmur
  • left ventricular lift (heave)
  • double apical impulse or double carotid pulsation
  • family history of sudden death
Full details

Other diagnostic factors

  • younger male (<50 years)
  • dyspnea
  • angina
  • palpitations
  • irregularly irregular pulse
  • older female (>50 years)
  • collapse
  • fourth heart sound
Full details

Risk factors

  • family history of HCM or sudden cardiac death
Full details

Diagnostic tests

1st tests to order

  • ECG
  • creatine kinase (CK)
  • liver function tests
  • renal function tests
  • N-terminal pro-brain natriuretic peptide (NT-proBNP)
  • troponin
  • urinalysis
  • CXR
  • transthoracic echocardiography with Doppler
Full details

Tests to consider

  • exercise ECG
  • Holter monitoring
  • nuclear imaging exercise test
  • cardiac magnetic resonance (CMR)
  • cardiac computed tomography (CT)
  • CT coronary arteriography
  • cardiac catheterization
  • stress echocardiography
  • exercise echocardiography
  • transesophageal echocardiography
  • endomyocardial biopsy
  • genetic mutation analysis
Full details

Treatment algorithm

INITIAL

asymptomatic

ACUTE

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

symptomatic: predominant nonobstructive with preserved systolic function

ONGOING

symptomatic: end-stage heart failure with systolic dysfunction

Contributors

Authors

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 serves as a steering committee member/local investigator and his institution has received research funding for hypertrophic cardiomyopathy-related clinical trials sponsored by Bristol Myers Squibb; Cytokinetics Inc.; Tenaya Pharmaceuticals; and Imbria Pharmaceuticals.

Acknowledgements

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

Disclosures

MM, 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.

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  • Guidelines

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    • ESC Guidelines for the management of cardiomyopathies
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  • Videos

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