Fast Five Quiz: Hypertrophic Cardiomyopathy Presentation and Diagnosis

Jamshid Shirani, MD


July 30, 2021

Figure 2. Hypertrophy of the cardiac interventricular septum seen on ultrasound.

Echocardiography is the foundational imaging modality for initial evaluation and for assessment of new or worsening symptoms in patients with HCM.

Cardiac MRI is an important complementary imaging technique, offering high spatial resolution and full tomographic imaging of the heart, as well as assessment of myocardial fibrosis (using late gadolinium enhancement imaging) on delayed images following injection of contrast. Cardiac MRI can clarify a diagnosis when the echocardiographic examination is inconclusive or when HCM is suspected based on cardiac symptoms, an abnormal 12-lead ECG, or family history.

Invasive hemodynamic studies may be useful in patients with a history of significant limiting heart failure symptoms or when the presence or magnitude of a LV outflow tract gradient on cardiac imaging is not clear. These studies can clarify the presence of resting or latent outflow tract obstruction and offer additional information on cardiac output and filling pressures.

Stress echocardiography can be beneficial when the presence or severity of LV outflow tract obstruction is uncertain after echocardiogram.

Learn more about the workup of HCM.


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