Summary
Definition
History and exam
Key diagnostic factors
- family history of HCM
- history of presyncope or syncope
- systolic ejection murmur
- left ventricular lift
- double apical impulse or double carotid pulsation
- family history of sudden death
Other diagnostic factors
- younger male (<50 years)
- dyspnea
- angina
- palpitations
- irregularly irregular pulse
- older female (>50 years)
- collapse
- fourth heart sound
Risk factors
- family history of HCM or sudden cardiac death
Diagnostic investigations
1st investigations to order
- ECG
- CXR
- echocardiography
Investigations to consider
- exercise ECG
- Holter monitoring
- nuclear imaging exercise test
- CT coronary arteriography
- cardiac catheterization
- cardiac MRI
- genetic mutation analysis
Treatment algorithm
asymptomatic
symptomatic: predominant left ventricular (LV) outflow tract obstruction with preserved systolic function
symptomatic: predominant nonobstructive with preserved systolic function
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 declares that he has no competing interests.
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.
Differentials
- Athlete's heart
- Discrete subaortic stenosis
- LVH due to hypertension
More DifferentialsGuidelines
- Recommendations for multimodality cardiovascular imaging of patients with hypertrophic cardiomyopathy
- 2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy
More GuidelinesVideos
Fourth heart sound gallop
More videosLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer