Hypertrophic Cardiomyopathy Cardiovascular Medicine


o Hypertrophic cardiomyopathy (HCM) has classically been defined as hypertrophy of the myocardium greater than 1.5 cm without an identifiable cause.
o The disorder has a variable presentation and carries a high incidence of sudden death.


o The mortality rate for individuals with HCM is 4% per year.
o HCM is slightly more common in males than in females.
o HCM usually presents at an earlier age in females than in males.

Signs and Symptoms:

o patients with HCM may be asymptomatic.
o symptoms of HCM can include sudden cardiac death
o dyspnea
o syncope
o presyncope
o angina
o palpitations
o orthopnea
o dyspnea
o congestive heart failure
o dizziness

Death often is sudden and unexpected and typically is associated with sports or vigorous exertion. (see young athlete at the figure)

Physical Findings:

o The classic auscultatory finding for HCM is a crescendo-decrescendo systolic murmur along the left sternal border that increases with the Valsalva maneuver, (See the young athlete that is more powerfull while standing and with valsava maneuver, similarly squatting and hand grip decreases his power and the intensity of his murmur).


Imaging Studies:

o Two-dimensional echocardiography reveals LV hypertrophy and is diagnostic for HCM.


o Cardiac catheterization
o Electrophysiology studies

Surgical Care:

o Left ventricular myomectomy.
o Pacemaker implantation
o Catheter septal ablation
o Implantable cardioverter defibrillator

July 31, 2006