Fast Five Quiz: Hypertrophic Cardiomyopathy Presentation and Diagnosis

Jamshid Shirani, MD


July 30, 2021

Figure 1. Hypertrophic cardiomyopathy.

Clinical diagnosis of HCM in adult patients can be established by a maximal end-diastolic wall thickness of ≥15 mm in any segment of the left ventricle when there is no other cardiac, vascular, or systemic cause of hypertrophy. In patients with a family history of HCM, or in patients with positive genetic test results, left ventricular wall thickness of 13-14 mm may be considered diagnostic.

Systolic anterior motion of the mitral valve leaflet(s) and hyperdynamic LV function are both common in HCM, but neither is diagnostic. Similarly, the following phenotypic expressions, although common, are not essential for diagnosis: right ventricular hypertrophy, hypertrophied and apically displaced papillary muscles, myocardial crypts, anomalous insertion of the papillary muscle directly in the anterior leaflet of the mitral valve (without interposing chordae tendineae), elongated mitral valve leaflets, and myocardial bridging of epicardial coronary arteries.

Learn more about the clinical presentation of HCM.


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