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General Medicine

Hypertrophic Cardiomyopathy

Muhannad Almubarak, MD, Arka Chatterjee, MD and Ihab Hamzeh, MD, FACC Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Hypertrophic cardiomyopathy (HCM) is a form of primary myocardial hypertrophy, with or without presence of left ventricular outflow tract (LVOT) obstruction; it is characterized by f...

DIAGNOSIS

HISTORY

  • Symptoms of heart failure: dyspnea, paroxysmal nocturnal dyspnea, fatigue

  • Angina pectoris

  • Palpitations

  • Exertional syncope or presyncope

  • Symptoms may be worsened by anemia, hot and humid w...

TREATMENT

  • These patients must be counseled against competitive athletics, irrespective of LVOT obstruction, presence of ICD, previous septal reduction therapy, and associated symptoms (3,4).

  • Adequate h...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Annual follow-up is recommended for stable patients.

  • Among the first-degree relatives, screening with ECG and echo is recommended every 12 to 18 months between age...

REFERENCES

1
Liew AC, Vassiliou VS, Cooper R, et al. Hypertrophic cardiomyopathy-past, present and future. J Clin Med.  2017;6(12). [View Abstract on OvidMedline]
2
Maron BJ. Contemporary insights a...

ADDITIONAL READING

  • Brothers MB, Oster ME, Ehrlich A, et al. Novel electrocardiographic screening criterion for hypertrophic cardiomyopathy in children. Am J Cardiol.  2014;113(7):1246–1249.

  • Cooper...

CODES

ICD10

  • I42.2 Other hypertrophic cardiomyopathy

  • I42.1 Obstructive hypertrophic cardiomyopathy

ICD9

  • 425.18 Other hypertrophic cardiomyopathy

  • 425.11 Hypertrophic obstructive cardiomyopathy

SNOMED

  • 233873004...

CLINICAL PEARLS

  • HCM should be considered in all patients with a history of unexplained SCD. It is the most common cause of SCD in young athletes in the United States.

  • Delayed de novo onset of LVH may o...

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FIGURE 4.51. Parasternal long-axis view recorded in a patient with hypertrophic cardiomyopathy being considered for alcohol septal reduction therapy. Top: Image was recorded at baseline. Note the hypertrophy of the ventricular septum and the systolic anterior motion of the mitral valve. Bottom: Image was recorded after injection of a diluted perfluorocarbon-based contrast agent into a septal perforator artery. Note the absence of contrast effect in the ventricula...
FIGURE 4.51. Parasternal long-axis view recorded in a patient with hypertrophic cardiomyopathy being considered for alcohol septal reductio...
Hypertrophic cardiomyopathy. The gross image shows a coronal section of a heart with marked asymmetric septal hypertrophy. The interventricular septum is 2.5 times thicker than the LV free wall. The anterior leaflet of the mitral valve is in very close apposition to the LV outflow tract. The bottom panel is a light micrograph showing marked myocyte disarray, where the individual myocytes no longer have a parallel orientation with respect to each other. Instead, they have a "storiform" array...
Hypertrophic cardiomyopathy. The gross image shows a coronal section of a heart with marked asymmetric septal hypertrophy. The interventric...
FIGURE 1-4. Myocardial hypertrophy. Cross-section of the heart of a patient with long-standing hypertension shows pronounced, concentric left ventricular hypertrophy.
FIGURE 1-4. Myocardial hypertrophy. Cross-section of the heart of a patient with long-standing hypertension shows pronounced, concentric le...
FIGURE 11-43. Hypertrophic cardiomyopathy (HCM).A. The heart has been opened to show striking asymmetric left ventricular hypertrophy. The interventricular septum is thicker than the free wall of the left ventricle and impinges on the outflow tract such that it contacts the underside of the anterior mitral valve leaflet. B. A section of the myocardium shows the characteristic myofiber disarray and hyperplasia of interstitial cells. C. A small intramural coronary ...
FIGURE 11-43. Hypertrophic cardiomyopathy (HCM).A. The heart has been opened to show striking asymmetric left ventricular hypertrophy. The ...
Figure 33-45 Echocardiographic parasternal long-axis view of a diabetic mother's infant with severe hypertrophic cardiomyopathy and subaortic ventricular septal defect. <, ventricular septal defect; AV, aortic valve; IVS, interventricular septum; LA, left atrium; LV, left ventricle; RV, right ventricle.
Figure 33-45 Echocardiographic parasternal long-axis view of a diabetic mother's infant with severe hypertrophic cardiomyopathy and subaort...
Hypertrophic cardiomyopathy. The heart has been opened to show striking asymmetric left ventricular hypertrophy. The interventricular septum is thicker than the free wall of the left ventricle and impinges on the outflow tract.
Hypertrophic cardiomyopathy. The heart has been opened to show striking asymmetric left ventricular hypertrophy. The interventricular septu...
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