What findings are common in patients with obstructive hypertrophic cardiomyopathy?

Q: Which clinical manifestation is associated with hypertrophic cardiomyopathy HCM )?

Clinical manifestations in HCM are highly variable20. Classical symptoms in HCM are usually related to left ventricular outflow tract (LVOT) obstruction, mitral regurgitation, myocardial ischemia, diastolic dysfunction, abnormal vascular responses, and supraventricular and ventricular arrhythmias20, 21.

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The Present and FutureJACC State-of-the-Art ReviewManagement of Hypertrophic Cardiomyopathy: JACC State-of-the-Art Review
Abbreviations and Acronyms
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Which findings are characteristic of hypertrophic cardiomyopathy?
Which finding on physical examination would be suggestive of a diagnosis of hypertrophic obstructive cardiomyopathy?
Which clinical manifestation is associated with hypertrophic cardiomyopathy HCM )?
How is obstructive hypertrophic cardiomyopathy diagnosed?

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The Present and FutureJACC State-of-the-Art ReviewManagement of Hypertrophic Cardiomyopathy: JACC State-of-the-Art Review

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Highlights

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Contemporary treatments have effectively transformed HCM into a highly treatable condition with relatively low morbidity/mortality.

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Sudden death in patients with HCM can be prevented through risk stratification and use of ICDs.

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Surgical myectomy has become a highly effective, low-risk operation in experienced centers to relieve outflow tract obstruction and symptoms.

Abstract

Hypertrophic cardiomyopathy (HCM), a relatively common, globally distributed, and often inherited primary cardiac disease, has now transformed into a contemporary highly treatable condition with effective options that alter natural history along specific personalized adverse pathways at all ages. HCM patients with disease-related complications benefit from: matured risk stratification in which major markers reliably select patients for prophylactic defibrillators and prevention of arrhythmic sudden death; low risk to high benefit surgical myectomy (with percutaneous alcohol ablation a selective alternative) that reverses progressive heart failure caused by outflow obstruction; anticoagulation prophylaxis that prevents atrial fibrillation-related embolic stroke and ablation techniques that decrease the frequency of paroxysmal episodes; and occasionally, heart transplant for end-stage nonobstructive patients. Those innovations have substantially improved outcomes by significantly reducing morbidity and HCM-related mortality to 0.5%/y. Palliative pharmacological strategies with currently available negative inotropic drugs can control symptoms over the short-term in some patients, but generally do not alter long-term clinical course. Notably, a substantial proportion of HCM patients (largely those identified without outflow obstruction) experience a stable/benign course without major interventions. The expert panel has critically appraised all available data and presented management insights and recommendations with concise principles for clinical decision-making.

Key Words

atrial fibrillation

defibrillation

heart failure

hypertrophic cardiomyopathy

stroke

sudden death

surgery

Abbreviations and Acronyms

ASA

alcohol septal ablation

HCM

hypertrophic cardiomyopathy

ICD

implantable cardioverter-defibrillator

LGE

late gadolinium enhancement

NYHA

New York Heart Association

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Which findings are characteristic of hypertrophic cardiomyopathy?

Signs and symptoms of hypertrophic cardiomyopathy might include one or more of the following: Chest pain, especially during exercise. Fainting, especially during or just after exercise or exertion. Heart murmur, which a health care provider might detect while listening to the heart.

Which finding on physical examination would be suggestive of a diagnosis of hypertrophic obstructive cardiomyopathy?

On physical examination, the presence of a harsh crescendo–decrescendo systolic murmur at the lower left sternal border, a mid–late systolic apical murmur or holosystolic apical murmur, and/or paradoxically split S2 should alert clinicians to the possibility of HCM.

Which clinical manifestation is associated with hypertrophic cardiomyopathy HCM )?

Clinical manifestations in HCM are highly variable²⁰. Classical symptoms in HCM are usually related to left ventricular outflow tract (LVOT) obstruction, mitral regurgitation, myocardial ischemia, diastolic dysfunction, abnormal vascular responses, and supraventricular and ventricular arrhythmias²⁰^, ²¹.

How is obstructive hypertrophic cardiomyopathy diagnosed?

Echocardiogram. An echocardiogram is commonly used to diagnose hypertrophic cardiomyopathy. This test uses sound waves (ultrasound) to see if the heart's muscle is unusually thick. It also shows how well the heart's chambers and valves are pumping blood.